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DOCUMENT 
No.  166 


VOCATIONAL  REHABILITATION 

OF  DISABLED  SOLDIERS 

AND  SAILORS 


LETTER  FROM  THE  FEDERAL  BOARD  FOR 
VOCATIONAL  EDUCATION 

TRANSMITTING,  IN  RESPONSE  TO  A  SENATE 
RESOLUTION  OF  JAN.  27,  REPORT  ON 

A  PRELIMINARY  STUDY  BY  THE  FEDERAL  BOARD 

ENTITLED  "VOCATIONAL  REHABILITATION 

AND  PLACEMENT  OF  DISABLED 

SOLDIERS  AND  SAILORS" 


JANUARY  30,  1918. — Referred  to  the  Committee  on  Education 
and  Labor  and  ordered  to  be  printed 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 
1918 


POT. 


FEDERAL  BOARD  FOR  VOCATIONAL  EDUCATION. 

MEMBERS. 

DAVID  F.  HOUSTON,  Chairman,  JAMES  P.  MUNROE, 

Secretary  of  Agriculture.  Manufacture  and  Commerce. 

WILLIAM  C.  REDFIELD,  CHARLES  A.  GREATHOUSE, 

Secretary  of  Commerce.  Agriculture. 

WILLIAM  B.  WILSON,  ARTHUR  E.  HOLDER, 

Secretary  of  Labor.  Labor. 

P.  P.  CLAXTON,  Commissioner  of  Education. 

EXECUTIVE    STAFF. 

C.  A.  PROSSER,  Director. 
LAYTON  S.  HAWKINS,  JOSEPHINE  T.  BERRY, 

Assistant  Director  for  Assistant  Director  for  Home 

Agricultural  Education.  Economics  Education. 

LEWIS  H.  CARRIS,  CHARLES  H.  WINSLOW, 

Assistant  Director  for  Assistant  Director  for  Research. 

Industrial  Education. 
CHEESMAN  A.  HERRICK, 
Special  Agent  for 

Commercial  Education. 
2 


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DOCUMENT 
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65TH  CONGRESS,  «     ™«     1ftQ 

9n    Su-HQTrkM  O»     XtJaO.     JLO*7. 


2D  SESSION. 


IN  THE  SENATE  OF  THE  UNITED  STATES. 

JANUARY  28,  1918. 

Mr.     SMITH    of    Georgia    submitted    the    following    resolution;    which    was 
considered  and  agreed  to. 


RESOLUTION. 

1  Resolved,    That   the    Federal   Board   for   Vocational   Edu- 

2  cation  be  directed  to  furnish  to  the  Senate  such  information 

3  as  it  may  have  or  can  readily  obtain  on  the  rehabilitation 

4  and   vocational   reeducation   of   crippled   soldiers   and   sailors. 


371848 


LETTER  OF  TRANSMITTAL. 


FEDERAL  BOARD  FOR  VOCATIONAL  EDUCATION, 

OFFICE  OF  THE  BOARD, 
Washington,  January  29,  1918. 
lion.  THOMAS  R.  MARSHALL, 

President  United  States  Senate, 

Washington,  D.  C. 

SIR:  The  Federal  Board  for  Vocational  Education  is  in  receipt  of 
the  following  resolution  of  the  Senate  of  January  28,  1918: 

Resolved,  That  the  Federal  Board  for  Vocational  Education  be  directed  to  furnish 
to  the  Senate  such  information  as  it  may  have  or  can  readily  obtain  on  the  rehabilitation 
and  vocational  reeducation  of  crippled  soldiers  and  sailors. 

Pursuant  thereto  there  is  herewith  transmitted  a  preliminary  study 
by  the  Federal  board  entitled  "  Vocational  Rehabilitation  and  Place- 
ment of  Disabled  Soldiers  and  Sailors." 
Respectfully, 

JAMES  P.  MUNROE, 

I  'ice  Chairman. 


TABLE  OF  CONTENTS. 


PART  I. — General  principles  and  policies:  Page. 

Foreword 9 

The  problem 

The  need  for  vocational  education  for  disabled  soldiers  and  sailors 

1.  To  insure  economic  independence 

2.  To  avoid  vocational  degeneration 

3.  To  prevent  exploitation 

4.  To  conserve  trade  skill 

5.  To  insure  national  rehabilitation 

6.  To  adjust  supply  of  labor  to  demand 

7.  To  develop  new  vocational  efficiency 

Cost  of  vocational  reeducation 

Preparation  for  victims  of  industry  after  the  war 

Specific  services  to  be  rendered . . ' 

Immediate  action  required 

Public  support 

Public  versus  private  control  and  administration 

Military  discipline 

National  versus  State  administration  and  control 

Cooperation  with  the  States 20 

Cooperation  with  private  agencies 21 

Financing  the  work  of  vocational  rehabilitation 21 

Appropriation  by  the  Federal  Government 22 

!a)  Provision  for  preliminary  survey  work 22 
b)  Provision  for  the  conduct  of  vocational  reeducation  work 22 
e)  Provision  for  support  of  men  and  their  dependents  during  the 

period  of  reeducation 22 

Appropriation  by  the  States 22 

Appropriation  by  municipalities 23 

Contributions  by  private  and  semipublic  agencies 23 

Need  for  training  teachers  for  rehabilitation 24 

Need  for  early  enactment  of  legislation 26 

Conference  to  formulate  a  comprehensive  plan  of  rehabilitation 28 

Legislation  must  be  broad  and  flexible 29 

PART  II. — Foreign  legislation  and  experience: 

Coordination  and  centralization  of  authority. .'. 31 

England ; 

Naval  and  military  war  pensions  act  of  1915 32 

Work  of  the  statutory  committee 33 

Temporary  allowance 34 

Hospital  discharges 35 

Provision  for  reeducation 36 

Ministry-of-pensions  act 36 

Naval  and  military  war-pensions  act  of  1917 37 

Regulations  for  training  disabled  men 38 

Employment 39 

Trade  advisory  committees 39 

Advisory;  wages  boards 40 

Inquiry  into  trades 40 


8  -  •      CONTENTS. 

PART  II. — Foreign  legislation  and  experience— Continued. 

France:  Page. 

Early  efforts  for  reeducation 42 

Office  national  des  mutiles  et  relormes  de  la  Guerre 43 

Provincial  committees 45 

Rehabilitation 45 

Register 46 

Inquiry  into  trades 46 

Reservation  of  employments 46 

Employee's  liability  in  case  of  injury 47 

Canada: 

Military  hospitals  commission 47 

Purposes  and  methods  of  the  commission 49 

Blank  forms  used  by  military  hospitals  commission 50 

Belgium 55 

Australia 55 

Italy 55 

South  Africa 57 

Newfoundland 57 

India 58 

New  Zealand 58 

PART  III. — The  size  of  the  problem: 

Some  factors  to  be  taken  into  consideration  in  estimating  the  number  that 

will  require  vocational  reeducation 50 

PART  IV. — Outline  for  an  exhaustive  study  and  report: 

Vocational  reeducation  and  placement  of  disabled  soldiers  and  sailors 73 

PART  V.— A  bibliography  of  the  war  cripple 77 


FOREWORD. 

This  document  is  the  outcome  of  a  special  research  ordered  by  the 
Federal  Board  for  Vocational  Education  on  August  16,  1917.  The 
board  took  this  step  because  it  recognized  that  the  United  States 
would  soon  be  confronting  the  problem  of  rehabilitating  the  disabled 
soldiers  and  sailors  resulting  from  the  great  war.  As  the  vocational 
reeducation  of  these  men  has  come  to  be  a  vital  part  of  their  rehabili- 
tation, it  is  believed  that  the  study  here  presented  may  be  of  service 
in  the  discharge  of  our  great  obligation  as  a  people  to  those  injured  in 
the  national  defense. 

The  experience  of  our  allies  in  vocational  rehabilitation  has  been 
collated  and  analyzed.  The  lessons  gained  by  them  are  presented  for 
the  guidance  of  all  those  interested  in  the  problem  in  our  own  country. 
Certain  general  principles  and  policies  toward  which  this  experience 
points  have  been  put  forth  as  the  basis  of  any  sound  program  of  Fed- 
eral legislation  and  national  action. 

While  the  report  deals  primarily  with  the  handicapped  soldier 
and  sailor,  attention  is  directed  particularly  to  the  discussion  of  the 
possibility  of  providing  vocational  reeducation  for  the  victims  of 
industry  as  well  as  of  war. 

The  report  also  outlines  a  complete  series  of  studies  of  the  entire 
problem  as  the  basis  for  future  and  more  detailed  investigations  in 
this  field. 

This  study  was  made  by  Dr.  John  Cummings  under  the  supervision 
of  Charles  H.  Winslow,  assistant  director  for  reasearch.  Acknowl- 
edgments for  valuable  suggestions  are  hereby  made  to  T.  B.  Kidner, 
vocational  secretary  of  the  Canadian  Military  Hospitals  Commission; 
Royal  Meeker,  Commission  of  Labor  Statistics;  and  R.  M.  Little, 
chairman  of  the  United  States  Employees  Compensation  Commis- 
sion. 

C.  A.  PROSSER,  Director. 


VOCATIONAL  REHABILITATION  AND  PLACEMENT  OF  DISABLED 
SOLDIERS  AND  SAILORS. 


PART  I. 
GENERAL  PRINCIPLES  AND  POLICIES. 

Soon  the  United  States  will  be  facing  the  many  problems  involved 
in  the  rehabilitation,  reeducation,  and  placement  of  soldiers  and 
sailors  disabled  in  the  war.  The  first  question  is  the  size  of  the  task 
in  terms  of  numbers  of  handicapped  men  to  be  dealt  with. 

THE    PROBLEM. 

Any  estimate  of  the  number  that  will  be  returned  disabled  or  that 
will  require  vocational  reeducation  must  necessarily  be  based  upon 
certain  assumptions  regarding  the  duration  of  the  war,  the  number 
of  men  maintained  at  the  front,  and  the  proportion  of  casualties. 
These  assumptions  must  be  based  upon  the  experience  of  the  bellige- 
rents during  the  last  three  years. 

There  are  at  present  approximately  13,000,000  wounded  and 
crippled  soldiers  in  the  belligerent  countries  of  Europe,  including 
3,000,000  cases  of  amputation.  In  Germany  alone,  it  is  reported, 
500,000  men  are  under  treatment  in  the  hospitals,  the  number  of  leg 
amputations  during  1916  being  16,000. 

During  the  next  few  months  the  return  of  wounded,  crippled,  and 
invalided  men  from  the  over-seas  forces  of  the  United  States  will 
begin,  and  will  continue  thereafter  for  an  indefinite  period  until  the 
return  of  the  over-seas  forces  after  the  termination  ot  the  war. 

Without  taking  account  of  more  remote  contingencies,  it  seems  not 
improbable,  as  statistics  given  in  Part  III  show,  that  100,000  dis- 
abled men  will  be  returned  during  the  first  year  of  fighting  and  that 
at  least  20,000  of  these  men  will  require  total  or  partial  vocational 
reeducation  in  order  to  overcome  handicaps  incurred  in  service. 

A  second  year  of  fighting  may  add  40,000,  a  third  60,000  to  the 
number  requiring  such  reeducation,  making  a  total  for  three  years 
of  lighting  of  120,000.  This  assumes  1,000,000  men  overseas  the 
first  year,  and  an  increase  of  1,000,000  men  overseas  in  each  suc- 
ceeding year. 

The  figures  given  above  may  underestimate  the  development  of 
the  overseas  forces,  as  well  as  the  proportion  of  casualties  in  the 
closing  stages  of  the  war,  when  offensive  strategy  and  tactics  and 
fighting  in  the  open  to  break  through  the  German  lines  may  succeed 
the  trench  warfare  of  the  past  two  years. 

11 


12     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

THE  NEED  FOR  VOCATIONAL  EDUCATION  FOR  DISABLED  SOLDIERS  AND 

SAILORS. 

Every  one  of  the  leading  European  countries  engaged  in  the  great 
war  has  already  made  provision  for  the  vocational  reeducation  and 
placement  of  disabled  soldiers  and  sailors.  The  consideration  which 
moved  England,  Canada,  France,  Italy,  Germany,  and  Austria  to 
undertake  this  work  is  one  which  will  appeal  with  even  greater  force 
to  the  people  of  this  country. 

Such  training  is  required: 

1.  To  insure  economic  independence. — Vocational  reeducation  will 
reestablish  the  disabled  soldier  or  sailor  as  an  independent,  self- 
respecting  economic  unit.     Any  other  policy  will  inevitably  induce 
economic  dependency  with  its  inherent  moral  and  social  evils.     For 
these  men  and  for  the  community  also,  moral  and  social  as  well  as 
economic  well-being,  is  in  a  large  measure,  at  stake. 

It  is  to  be  noted  that  the  age  of  the  conscripted  army  (21  to  31 
years)  is  such  that  the  men  are  young  enough  to  be  susceptible  to 
training,  and  that  the  benefits  of  such  training  will  accrue  during  a 
period  equivalent  to  the  normal  expectation  of  life  for  men  in  early 
manhood. 

Recognizing  the  value  of  vocational  training  some  of  the  men 
were  taking  such  training  when  drafted.  This  interrupted  training 
should  be  resumed. 

2.  To  avoid  vocational  degeneration. — Experience  has  demonstrated 
that  disabled  men  while  under  hospital  treatment  naturally  tend  in 
many  instances  to  fall  into  a  state  of  chronic  dependence,  characterized 
by  loss  of  ambition.     The  difficulty  of  lifting  them  out  of  this  well- 
recognized  phase  increases  rapidly  during  the  period  immediately 
following  convalescence.     Initiation   of  vocational  training  at  the 
earliest  possible  moment  and  persistent,  systematic  development  of 
this  training  after  convalescence  will  avoid  this  danger  of  vocational 
degeneration. 

Once  the  men  have  fallen  into  this  state  of  chronic  dependence  or 
have  drifted  back  into  industry  without  training,  they  can  not  be 
industrially  recovered. 

3.  To  prevent  exploitation. — Without  the  protection  of  vocational 
reeducation,  together  with  systematic  reestablishment  in  wage-earn- 
ing employment,  the  handicapped  man  will  drift  about  in  indus- 
try,  an  unskilled  laborer  and   a  subject  for  exploitation  by  the 
unscrupulous. 

4.  To  conserve  trade  skill. — The  policy  of  vocational  rehabilitation 
is  one  of  conservation.     Disabled  men  skilled  in  specific  trades  will 
be,  so  far  as  possible,  reestablished  in  those  trades  by  vocational 
reeducation.     Without  such  training  acquired  trade  experience  will 
in  many  cases  be  lost,  and  the  ranks  of  skilled  labor  will  be  to  that 
extent  depleted.     Incidentally,  the  drifting  of  handicapped  men  in 
any  considerable  number  into  unskilled  employments  will  occasion 
demoralization  and  impair  wage  standards. 

5.  To  insure  national  rehabilitation. — The  European  countries  have 
found  the  conservation  of  trade  skill  and  experience  to  be  a  factor 
of  vital  importance  in  national  rehabilitation.     In  these  countries  the 
conduct  of  industries,  commerce,  and  agriculture,  even  during  the  prog- 
ress of  the  war,  has  become  largely  dependent  upon  the  reestablish- 
ment in  civil  employment  of  men  disabled  for  further  military  service. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     13 

It  should  be  borne  in  mind  that  the  disabled  men  are,  in  many 
cases,  specially  trained  and  skilled.  If  allowed,  through  lack  of  such 
reeducation  as  they  require,  to  sink  into  the  ranks  of  the  unskilled, 
their  places  in  the  Nation's  scheme  of  economic  productivity  can 
not  be  filled.  No  supply  of  skilled  men  is  now,  or  will  be  after  the 
war,  available  from  other  countries,  since  every  country  at  war  is 
experiencing  and  will  continue  to  experience  in  the  years  following 
the  war  a  great  scarcity  of  skilled  labor. 

Vocational  reeducation  of  men  disabled  for  military  service  is, 
therefore,  a  means  not  only  of  conserving  trade  skill,  but  of  conserv- 
ing it  in  a  time  of  national  emergency  and  of  preventing  in  some 
degree  the  scarcity  of  skilled  labor  that  is  certain  to  develop  as  the 
war  progresses.  The  nation  which  does  not  conserve  the  vocational 
skill  of  its  trained  workers  will  to  that  extent  weaken  its  recuperative 
and  competitive  power  and  to  that  extent  will  consequently  fail  to 
achieve  the  immediate  national  rehabilitation  of  its  industrial, 
commercial,  and  agricultural  power. 

6.  To  adjust  supply  of  labor  to  demand. — The  return  to  civil  employ- 
ment of  larcje  numbers  of  men  under  the  abnormal  conditions  of  the 
period  of    demobilization  will  occasion   far-reaching  economic  dis- 
turbance and  maladjustment  of  labor  supply  to  demand,  unless  that 
return  is  made  under  some  comprehensive  scheme  of  administration. 
Vocational  reeducation  will  provide  one  means  of  so  directing  the 
return  of  men  into  civil  employments  as  to  occasion  the  least  possible 
disturbance,   and  will  go  far  to   avoid  impairment   of  established 
standards  of  living. 

7.  To    develop    new    vocational    efficiency. — In    individual    cases, 
undoubtedly,  new  vocational  capacities  will  be  developed  in  handi- 
capped men  by  systematic  vocational  reeducation.     In  many  cases 
the    selection    of    wage-earning    employments   has    been    originally 
accidental,  and  without  due  regard  to  natural  aptitude.     Vocational 
rehabilitation,  by  training  for  new  employments  for  which  the  men 
have  natural  aptitude,  may  develop  entirely  new  vocational  capaci- 
ties, making  the  men  even  more  efficient  producers  than  they  were 
before. 

Vocational  training  has  established  its  claim  as  a  means  of  produc- 
ing and  increasing  economic  efficiency,  and  in  the  Smith-Hughes 
Act,  among  others,  Congress  has  indorsed  this  sort  of  training  by 
appropriating  Federal  money  to  its  support  in  the  public  schools. 
Such  training  can  not  consistently  be  denied  to  the  disabled  soldier 
and  sailor — whose  need  is  special  and  peculiar  on  account  of  his 
handicap  incurred  in  the  public  service — while  extending  it  to  all 
other  workers  having  no  special  claim  to  Government  lavor.  All 
workers  may  have  their  productive  efficiency  increased  by  vocational 
training,  but  in  the  case  of  the  disabled  soldier  or  sailor  the  need 
of  such  training  is  imperative  and  the  obligation  to  give  it  is  clear. 

COST    OF    VOCATIONAL    REEDUCATION. 

The  immediate  expenditure  involved  in  vocational  training  for 
disabled  men  will  not  be  materially  greater  than  that  which  would  be 
involved  in  providing  financial  support  without  vocational  training. 
Under  any  scheme  the  disabled  men  must  be  provided  for  during 
disability.  In  its  initial  stages  vocational  rehabilitation  has  a 


14     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

recognized  therapeutic  value,  tending  to  hasten  convalescence. 
Established  hospital  practice  as  well  as  experience  in  England, 
France,  Canada,  and  other  belligerent  countries  has  demonstrated 
this  to  be  the  fact.  Convalescent  hospitals  must  be  in  any  event 
provided  and  equipped,  and  the  additional  expenditure  required  for 
vocational  rehabilitation  after  convalescence  will  not  materially 
increase  the  immediate  burden  of  the  war. 

Vocational  rehabilitation  can  not,  in  fact,  be  regarded  as  costing 
the  community,  except  temporarily,  anything  whatever.  The  dis- 
ability of  the  soldier  or  sailor  is  an.  economic  handicap  reducing  pro- 
ductive power.  Unless  the  men  are  vocationally  reestablished,  and 
to  the  extent  that  they  are  not  completely  reestablished,  the  economic 
loss  to  the  community  will  be  cumulative  during  a  long  period  of 
years.  Even  a  slight  increase  in  vocational  capacity,  as  a  result  of 
vocational  training  initiated  during  the  period  of  convalescence  and 
continued  for  a  few  weeks  or  months  after  convalescence,  will  result 
in  an  economic  gain  which,  also,  will  be  cumulative  over  a  long 
period.  This  aggregate  cumulative  gain  will  certainly  exceed  any 
expenditures  required  for  vocational  rehabilitation. 

If  the  only  alternative  policy  to  that  of  vocational  rehabilitation  be 
adopted,  namely,  the  policy  of  providing  financial  support  without 
vocational  training,  there  is  reason  to  believe,  judging  from  the 
experience  of  previous  wars  in  the  United  States,  that  the  financial 
burden  upon  the  community  will  not  be  materially  diminished  for 
many  years. 

The  expenditure  for  vocational  rehabilitation  is  necessarily  con- 
tinued over  only  a  very  brief  period.  Within  a  few  montns  the 
disabled  man  will  have  been  given  all  the  special  training  that  can 
advantageously  be  given  to  him.  The  current  expenditure  for 
vocational  rehabilitation  will  therefore  dimmish  rapidly  during  the 
months  immediately  following  the  war,  and  will  largely  terminate 
within  one  or  two  years.  The  cost  of  maintaining  the  disabled  man 
and  his  dependents  as  wards  for  their  natural  lifetime  would  certainly 
far  exceed  that  of  vocational  rehabilitation. 

PREPARATION    FOR    VICTIMS    OF    INDUSTRY   AFTER   THE    WAR. 

One  of  the  most  important  arguments  for  undertaking  the  voca- 
tional rehabilitation  01  disabled  soldiers  and  sailors  is  that  all  the 
experience  and  all  the  special  equipment  required  for  emergency  war 
work  will  be  needed  to  provide  for  similar  work  in. the  vocational 
rehabilitation  of  men  disabled  in  factories  and*  workshops,  of  the 
victims  of  accident  in  all  dangerous  employments,  and  of  the  thou- 
sands of  otherwise  injured  and  crippled  persons  thrown  upon  the 
community  each  year.  The  number  of  such  persons  in  normal  times 
greatly  exceeds  trie  capacity  thus  far  developed  for  their  vocational 
rehabilitation,  and  it  is  certain  that  the  experience  gained  in  the  war 
emergency,  together  with  the  special  equipment  and  capital  expendi- 
ture, can  be  utilized  in  industry  after  the  war  emergency  is  passed. 

SPECIFIC    SERVICES    TO    BE    RENDERED. 

The  problem  of  vocational  rehabilitation  would  seem  to  include 
the  following  services:  (1)  Registration  of  each  man  returned, 
including  a  description  of  his  disability,  or  any  condition  which  may 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     15 

prevent  him  from  earning  full  livelihood,  and  an  estimate  of  the 
degree  of  his  vocational  incapacity,  in  his  former  occupation,  if  ho 
can  return  to  it,,  or,  if  not,  in  some  other  occupation;  (2)  provision 
for  occupational  exercises  in  hospital  workshops  during  the  period  of 
convalescence;  (3)  provision  for  vocational  reeducation  of  convales- 
cents in  cases  requiring  such  training;  (4)  placement  in  a  wage- 
earning  occupation  of  men  vocationally  fit  or  rehabilitated ;  and  (5) 
continuous  registration  and  follow-up  work,  including  maintenance 
of  special  wage  agreements  where  enicieiicy  has  been  reduced,  and 
handicaps  determined. 

IMMEDIATE    ACTION    REQUIRED. 

Efficient  accomplishment  of  this  program  demands  immediate 
action.  Some  of  the  preliminary  steps  that  should  be  taken  at  once 
are:  (1)  Adequate  provision  for  the  financial  support  of  a  program  of 
vocational  reeducation  for  these  men;  (2)  organization  of  agencies 
to  secure  from  the  start  proper  administrative  control,  flexibility, 
and  cooperation;  (3)  survey  of  experience  and  achievement  in  this 
work  hi  foreign  countries;  (4)  survey  and  analysis  of  occupations 
and  industrial  processes  with  a  view  to  classification  in  terms  of 
handicaps;  (5)  survey  of  industrial  establishments  and  other  agencies 
of  employment;  (6)  development  of  courses  of  instruction  in  different 
occupations  for  type  handicaps;  (7)  training  of  teachers;  (8)  pro- 
vision of  suitable  equipment;  (9)  devising  of  new  methods  of  train- 
ing; (10)  adaptation  of  tools  and  of  machine  attachments  for  use  by 
the  handicapped;  (11)  development  of  an  organization  for  placing 
trained  men  in  wage-earning  employments  under  fair  conditions; 
(12)  development  of  a  scheme  of  registration  and  follow-up  work, 
with  reference  to  men  placed. 

The  steps  taken  by  Canada,  as  described  in  a  recent  report  of  the 
Canadian  Military  Hospitals  Commission,  furnishes  an  illuminating 
illustration  of  the  kind  and  magnitude  of  the  difficulties  involved. 
(See  Part  II,  pp.  31  to  64.) 

PUBLIC   SUPPORT. 

Whatever  private  resources  may  be  made  available  for  vocational 
rehabilitation,  the  obligation  is  clearly  upon  the  public  to  provide 
amply  for  this  work.  Every  European  nation  has  already  recog- 
nized and  has  written  this  obligation  into  legislation.  Some  of  the 
reasons  follow ; 

1.  The  public,  through  the  National  Government,   called  these 
men  into  military  service  where  they  incurred  injuries.     The  public 
is,  therefore,  under  obligation  to  bring  them  back  to  civil  life  rehabili- 
tated as  far  as  possible,  not  only  in  body  but  in  capacity  to  resume 
normal  economic  life. 

2.  Every  sacrifice  and  loss  sustained  to  save  the  institutions  of 
the  country  imposes  an  obligation  on  the  Nation  which  can  be  only 
partially   oLischarged   by   providing   vocational   reeducation   to   the 
fullest  possible  extent. 

3.  Through  the  enactment  by  Congress  of  the  war-risk  insurance 
bill,  as  well  as  through  the  physical  care  of  wounded  soldiers  by  the 
hospital  service  of  the  Army  and  Navy,  the  National  Government 


16     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

clearly  recognizes  a  responsibility  to  those  wounded  in  its  military 
service.  The  policy  of  supporting  rehabilitation  from  public  funds 
is  consistent  with  these  already  established  policies.. 

4.  The  disabled  soldier  and  sailor  of  the  present  war  has,  by  the 
legislation  already  enacted  by  Congress,  been  made  a  ward  of  the 
Nation,  and  the  obligation  to  give  him  vocational  training  is  cer- 
tainly as  great  as  in  the  case  of  other  national  wards,  such  as  the 
Indian. 

5.  Through  the  Smith-Hughes  Act,  the  Government  has  already 
recognized  its  obligation  to  give  vocational  training  to  the  civilian 
youth  of  the  country.     Its  obligation  to  give  such  training  to  the 
disabled  soldier  or  sailor  is  much  greater. 

6.  In  the  end  the  cost  of  the  work,  whether  carried  on  by  the 
public  or  by  private  funds,  will  be  borne  by  the  people.     The  burden 
is  a  democratic  right,  and  it  may  safely  be  assumed  that  the  people 
will  demand  as  a  privilege  the  opportunity  directly  to  discharge  their 
fundamental  obligation. 

It  may  be  urged,  however,  (a)  that  large  private  foundations 
are  or  will  be  available  for  carrying  on  the  vocational  rehabilitation 
of  disabled  soldiers  or  sailors,  that  they  will  prove  to  be  adequate, 
and  that  they  should  be  fully  utilized;  (?>)  that  if  developed  with 
private  resources,  an  opportunity  will  be  afforded  for  volunteer  ser- 
vice and  support,  which  otherwise  would  not  be  utilized;  (c)  that 
private  agencies,  being  highly  differentiated,  can  meet  the  diverse 
needs  of  individual  cases  more  completely  than  can  Government 
agencies;  and  (d)  that  by  utilizing  private  resources  the  burden 
of  taxation  upon  the  community  will  be  lessened. 

Against  the  policy  of  devolving  the  work  upon  private  resources 
the  following  contentions  may  be  presented  for  consideration: 

1.  Private  support  would  unavoidably  stigmatize  as  charity  the 
work  of  rehabilitating   the   disabled  soldiers   and  sailors,    a  work 
obviously  in  no  sense  a  charity,  but  clearly  the  partial  discharge  of 
an  obligation  resting  upon  the  whole  community. 

2.  The  work  of  rehabilitation  should  not  be  regarded  as  voluntary, 
but  should  be  accepted  as  obligatory  upon  the  community,  a  ser- 
vice to  be  provided  lor  out  of  taxation,  forcing  the  unwilling,  if  there 
be  any  such,  as  well  as  the  willing,  to  contribute. 

3.  Private  agencies  may  prove  inadequate  and  fail.     No  assur- 
ance whatever  can  be  obtained  in  advance  that  they  will  prove 
to  be  adequate  and  successful. 

4.  Private  resources  almost  certainly  will  not  be  available  in  dif- 
ferent sections  of  the  country  in  proportion  to  the  local  needs  for 
rehabilitation.     The  disabled  soldier  or  sailor  should  be  returned 
as  nearly  as  possible  to  his  home   community,    and  vocationally 
reestablished  in  that  community.     For  any  local  inadequacy  there 
would   be  no   certain   remedy   in   voluntarily   contributed   private 
resources. 

5.  Private  philanthropy  has  no  certain  and  continuous  sources 
from  which  to  derive  funds.     Neither  has  it  any  certain  resources 
capable  of  responding  adequately  to  meet  the  needs  of  a  sudden  emer- 
gency, such  as  may  develop  in  the  course  of  the  war. 

6.  The  history  of  such  institutions  as  asylums  for  the  deaf,  the  dumb, 
the  blind,  the  crippled  and  deformed,  show  a  general  tendency  to  pass 
from  private  to  public  support. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     17 

7.  Private  support  carries  with  it  always  some  measure  of  private 
control,  and  such  control  may  ultimately  prove  pernicious. 

It  is  fully  recognized,  of  course,  that  a  large  neld  is  open  for  the 
voluntary  cooperation  of  private  with  public  agencies  in  providing 
for  the  welfare  of  disabled  soldiers  and  sailors.  Private  resources  can 
render  service  in  making  studies,  in  conducting  experiments,  and  in 
preparing  teachers.  The  faculties  of  endowed  institutions  may  un- 
dertake to  give  training,  under  direction  of  the  National  Government, 
and  such  training  may  be  in  part  paid  for  by  the  National  Govern- 
ment. The  services  which  may  be  assumed  by  private  agencies  are 
indicated  in  the  account  of  the  activities  of  such  agencies  in  foreign 
countries.  (See  Part  II.) 

PUBLIC    VERSUS   PRIVATE   CONTROL   AND  ADMINISTRATION. 

The  following  arguments  have  been  advanced  in  support  of  private 
control  and  administration.  It  is  urged — 

1.  That  private  control  would  be  free  from  the  embarrassment  of 
legislative  definition  of  powers  and  functions,  and  free  to  adjust  itself 
to  needs  as  they  develop,  without  waiting  for  enabling  acts. 

2.  That  private  agencies  could  command  the  services  of  experts 
not  available  for  public  employment. 

3.  That  private  control  is  necessary  to  enlist  private  support,  which 
will  not  be  forthcoming  if  the  enterprise  be  retained  under  exclusive 
public  administration. 

4.  That  private   control  will   insure   the   cooperation   of   diverse 
agencies  already  in  existence. 

The  principal  arguments  advanced  in  support  of  public  control  and 
administration  are  the  following: 

(1)  The  Federal  Government  has  control  of  the  disabled  soldiers 
as  they  return  from  the  war,  and  is,  therefore,  under  the  immediate 
necessity  of  providing  for  them. 

(2)  Experience  has  shown  that  disabled  soldiers  for  the  period  of 
their  rehabilitation  should  be  returned,  as  far  as  possible,  to  their  own 
communities.     This  geographical  distribution  can  be  most  easily 
effected  by  the  Federal  Government. 

(3)  If  it  be  assumed  that  military  control  is  necessary  (see  section 
below)  during  the  whole  or  any  portion  of  the  period  of  rehabilita- 
tion, the  National  Government  alone  can  exercise  such  control. 

(4)  Since  the  question  of  public  versus  private  control  is  inti- 
mately bound  up  with  the  question  of  public  versus  private  support, 
any  decision  of  Congress  to  support  vocational  rehabilitation  with 
puolic  funds  implies  public  control  of  the  work. 

(5)  It  is  inconceivable  that  any  other  than  the  Federal  Govern- 
ment could  undertake  the  work  of  training  and  supplying  teachers 
to  meet  this  necessity  with  the  promptness  which  the  emergency 
requires,  and  on  a  scale  sufficiently  comprehensive. 

(6)  The  Nation  al  Government  is  in  a  position  to  utilize  agencies  and 
equipment  which  private  control  can  not  command.     Among  these 
may  be  mentioned  the  land-grant  colleges  already  cooperating  with 
the  National  Government  in  the  training  of  farmers,  and  forts,  can- 
tonments, and  extensive  open  places  already  belonging  to  the  National 
Government,  readily  convertible  into  sites  for  the  training  of  large 
numbers  of  men.     The  National  Government  could  not  turn  these 
resources  over  to  the  administration  of  private  philanthropy. 

42297°— S.  Doc.  166,  65-2 2 


18     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

(7)  As  regards  placement,  no  agency  other  than  the  Federal  Gov- 
ernment can  command  the  cooperation  of  every  class  in  the  fields  of 
commerce,  industry,  and  agriculture,  including  both  employer  and 
employee. 

(8)  Private  control,  or  private  support  on  any  large  scale  for  this 
work,  involves  an  idea  repugnant  to  the  American  mind — namely, 
that  these  soldiers  are  to  be  wards  of  charity  rather  than  the  recipi- 
ents of  their  just  dues  from  the  Government. 

(9)  The  Government,  by  every  consideration  of  justice  is  bound 
to  contribute  to  this  work,  and  since  it  can  not  turn  over  its  funds 
to  private  administration,  it  must  assume  control,  at  least  in  propor- 
tion to  its  financial  support. 

(10)  Private  control  necessarily  means  private  support,  and  since 
private  support  may  prove  inadequate  and  fail,  private  control  is 
not  feasible. 

(11)  As  a  direct  result  of  national  control  of  the  work  of  rehabili- 
tating crippled  soldiers  and  sailors,  experience  of  great  value  to  the 
Government  in  connection  with  similar  work  for  the  victims  of 
industry  will  be  gained. 

MILITARY  DISCIPLINE. 

Wounded  soldiers,  being  in  an  abnormal  condition  psychologically 
and  physically,  dp  not  in  every  case  realize  the  necessity  for  under- 
going the  immediate  sacrifice  involved  in  vocational  training,  and 
must  therefore,  for  their  own  best  interests,  be  induced  to  follow  it. 
The  maintenance  of  military  discipline  in  the  initial  stages  of  this 
training  would  be  one  method  of  bringing  needed  pressure  to  bear. 
Release  from  such  discipline  should,  however,  in  general  be  given  at 
the  earliest  moment  when  it  appears  on  special  consideration  of 
individual  cases,  that  its  further  continuation  is  not  essential  to  com- 
plete rehabilitation  in  civil  employment. 

At  the  same  time  it  is  to  be  borne  in  mind  that  the  sudden  release 
of  men  accustomed  to  military  discipline  from  such  control,  might 
impose  burdens  of  responsibility  upon  them  at  precisely  that  time 
when  they  would  be  unfit  to  bear  them. 

If  the  best  interests  of  the  community  demand,  for  reasons  noted, 
the  Government  will  direct,  guide,  and  control  the  work  of  rehabili- 
tation for  a  considerable  period,  at  least.  Without  such  control  it 
would  be  difficult  for  the  Government  to  act  effectively,  as  a  sort 
of  switchboard  connecting  the  men  with  industrial  life,  having  pur- 
view of  all  vocational  opportunities  throughout  the  country,  and 
directing  rehabilitated  men  into  those  employments  for  which  there 
is  the  greatest  need. 

It  is  recognized  that  a  large  majority  of  these  men  have  been 
drafted  for  the  period  of  the  war  and  that  at  the  termination  of  the 
war  they  will,  unless  additional  legislation  is  enacted,  be  free  to 
leave  the  Army.  For  handicapped  men  who  do  so  leave  the  Army 
it  is  clear  that  some  provision  for  systematic  vocational  training  by 
the  Government  must  be  made,  and  that  vocational  training  at  the 
expense  of  the  Federal  Government  necessarily  implies  control  dur- 
ing the  period  of  such  training. 

Over  crippled  and  disabled  men,  returned  before  the  close  of 
the  war,  the  Government  will  still  exercise  control.  These  men, 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     19 

at  least,  should  be  continued  under  Government  control  during  phys- 
ical rehabilitation.  If  they  are  not  so  retained  the  Government 
will  be  in  the  position  of  releasing  upon  the  community  handicapped 
men  drafted  for  the  period  of  the  war  without  providing  for  their 
rehabilitation  and  readjustment  to  civil  life. 

As  regards  extension  of  military  discipline  the  correct  procedure 
would  appear  to  be  release  from  such  discipline  upon  completion  of 
convalescence  and  continuation  ^  of  training  under  civil  discipline. 
But  this  question  is  one  of  administrative  policy  rather  than  of  legis- 
lation ana  may  safely  be  left  for  determination  by  such  executive 
board  or  authority  as  may  be  instituted  to  carry  on  the  work. 

The  duration  of  the  vocational  courses  will  doubtless  be  short, 
varying  from  a  few  weeks  or  months  to  one  or  two  years.  Much  of 
this"  training  might  well  be  on  a  part-time  basis,  the  rnan  being 
employed  in  an  approved  factory  or  shop  and  attending  school 
under  the  continuation  plan. 

The  point  at  which  Government  control  should  be  discontinued 
must  be  determined  individually  and  on  the  general  principle  that 
for  the  control  ends  when  the  in  dividual  has  been  restored  as 
y  as  possible  to  normal  physical,  mental,  and  vocational  indepen- 
dence, and  when  provision  has  been  made  for  his  securing  and  holding 
a  position.  If  not  completely  rehabilitated,  adequate  provision 
should  be  made  for  his  further  vocational  training  by  some  private 
enterprise. 

NATIONAL    VERSUS    STATE    ADMINISTRATION    AND    CONTROL. 

Leaving  for  separate  consideration  the  development  of  the  under- 
lying principles  of  cooperation  between  the  Federal  Government  and 
the  States,  the  broad  question  of  National  versus  State  administra- 
tion and  control  may  be  briefly  presented.  To  this  general  question 
the  following  considerations  seem  pertinent. 

1.  While  these  men  have  been  drafted  from  the  States  in  pro- 
portion to  population,  there  is  no  reason  to  expect  that  they  will  be 
disabled  in  the  same  proportions.     The  burden  for  caring  for  these 
men  should  not  be  apportioned  by  the  accidental  incidence  of  war 
casualties,  but  should  be  assumed  as  a  national  burden  and  equitably 
distributed  to  the  States  through  the  National  Government.     Ob- 
viously those  States  which  experience  a  relatively  light  burden  of 
casualties  should  not  be  relieved  of  their  fair  share  of  taxation  for  the 
work  of  rehabilitation. 

2.  These  men  having  been  crippled  in  the  national  service,  it  be- 
comes the  duty  of  the  National  Government  to  supervise  their  voca- 
tional, just  as  it  assumes  the  task  of  their  physical,  rehabilitation. 

3.  State  control  implies  State  responsibility  for  the  rehabilitation 
of  soldiers,  and  the  National  Government  can  not  in  the  case  of  the 
States,  any  more  than  in  the  case  of  private  agencies,  divest  itself 
of  its  definite  responsibilities. 

4.  The  Smith-Hughes  and  other  acts  furnish  precedent  for  tne 
Federal  Government  to  contribute  money  and  to  fix  standards  for 
a  national  system  of  vocational  education.     It  should  be  noted,  how- 
ever, that  tlie  scheme  of  apportionment  of  Federal  money  under  the 
Smith-Hughes  Act  would  not  be  equitable  in  the  case  of  wounded 
soldiers  for  the  reason  that  such  wounded  men  will  not  be  in  propor- 
tion to  the  population  of  the  States. 


20     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

5.  In   the    adjustment    of  rehabilitated  men  to  industry  it  may 
develop  that  citizens  of  one  State  may  be  most  advantageously  placed 
in  some^  other  State.     This  redistribution  can  best  be  carried  on  by 
the  National  Government. 

6.  Experience  shows  that  the  obstacles  in  the  way  of  getting  uni- 
form  and   adequate   legislation  from   the   48   States   severally   are 
almost  insuperable  and  are  always  sufficient  to  occasion  great  delays. 
Should  vocational  rehabilitation  be  put  under  State  control,  it  is 
highly  improbable  that  all  of  the  States  would  provide  for  such  control 
within  a  period  of  two  to  three  years.     Therefore,  the  period  essential 
for  rehabilitation,  the  period  of  convalescence,  and  that  immediately 
following  would  have  lapsed  before  adequate  provision  had  been  made. 

7.  The  National  Government  has  larger  resources  than  any  State 
government,  and  with  regard  to  the  particular  resources  needed  for 
vocational  rehabilitation  it  is  already  in  position  to  cooperate  with 
a  vast  number  of  agencies  throughout  the  country. 

8.  Institutions  of  special  character  will  be  required  for  dealing  with 
specific  classes,  and  it  might  not  be  possible  for  a  State  having  a  com- 
paratively small  number  of  handicapped  men  to  provide  the  special 
institutions  necessary  for  their  most   advantageous  training.     The 
State  with  a  small  number  of  handicapped  could  not  provide  for 
these  men  special  institutions  and  specially  trained  teachers  for  voca- 
tionally reeducating  the  blind,  the  one-legged,  the  one-armed,  the  men 
seeking  rehabilitation  in  clerical  pursuits,  in  agriculture,  and  in  each 
of  the  separate  trades. 

Among  the  resources  of  the  Federal  Government  which  might  be 
utilized  for  this  work  are  the  land-grant  colleges,  army  posts,  forts, 
and  cantonments. 

9.  While  there  is  no  exact  parallel  in  European  Governments  for 
the  relationship  existing  between  our  National  Government  and  the 
several  States,  nevertheless  European  experience  in  the  present  war 
indicates  that  this  work  of  rehabilitation  must  be  under  national 
control,  even  when  the  work  is  done  in  cooperation  with  local  govern- 
ments, municipal  or  provincial,  or  with  private  agencies. 

10.  The  pension  acts  and  the  war-risk  insurance  act  furnish  prece- 
dent for  the  Federal  as  against  State  control. 

COOPERATION  WITH  THE  STATES. 

The  question  of  cooperation  between  the  National  Government 
and  the  States  does  not  involve  the  question  of  the  cost  of  the  work 
in  so  far  as  that  cost  is  to  be  provided  out  of  public  funds,  with  the 
exception,  however,  that  the  centralized  administration  would 
naturally  be  expected  to  be  cheaper  than  an  administration,  divided 
among  the  several  States.  Whether  the  money  is  contributed  in 
whole  or  in  part  by  the  State  governments  or  by  the  National  Gov- 
ernment, it  must  be  derived  from  taxation,  and  the  amount  raised 
will  be  determined  by  the  work  to  be  done  and  not  by  fiscal  agents. 

It  is  proposed  that  a  census  of  institutions  should  immediately  be 
undertaken  by  the  Federal  Board  for  Vocational  Education,  and 
that  this  census  secure  information  concerning  the  number  of  insti- 
tutions and  the  attitude  of  the  State  officials.  The  National  Govern- 
ment is  already  taking  an  occupational  census  of  the  drafted  men,  and 
will  be  in  possession  of  vocational  information  concerning  them. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     21 

The  numbers  of  those  trained  in  the  different  vocations  will  therefore 
be  known  in  advance  of  the  return  of  the  men. 

Inasmuch  as  under  the  Smith-Hughes  Act  the  States  are  rapidly 
developing  vocational  schools,  it  would  seem  wise  economy  to  expand 
and  adapt  these  schools  in  order  to  meet  the  new  necessity  as  well 
as  to  create  new  schools  specifically  designed  for  the  emergency  and 
under  direct  national  control.  It  is  suggested  that  since  to  accomplish 
this  it  may  be  necessary  for  the  States  to  modify  and  enlarge  their 
vocational  education  facilities,  the  Smith-Hughes  Act  should  be 
amended  at  the  earliest  moment  to  that  end,  in  order  that  it  may  effect 
that  end. 

COOPERATION     WITH     PRIVATE     AGENCIES. 

The  basis  of  cooperation  with  private  agencies  should  be  similar  to 
that  of  cooperation  with  the  States;  namely,  financial  contribution  or 
the  extension  of  the  resources  available  in  private  institutions  for  the 
effective  carrying  on  of  the  work. 

Cooperation  with  private  agencies  must  always  carry  with  it 
national  control,  and  no  cooperation  involving  the  surrender  of 
national  supervision  should  be  contemplated.  Such  control  does  not 
necessarily  involve  supervisory  functions  over  the  private  institu- 
tion, except  as  is  necessarily  involved  in  the  control  of  the  men  de- 
tailed to  such  institutions  during  vocational  rehabilitation. 
^  The  private  agencies  should  be  regarded  as  volunteers,  and  the 
Federal  Government,  whatever  services  it  may  accept,  should  not 
impose  anything  upon  them.  The  national  scheme  should  be  suf- 
ficiently elastic  to  accept  volunteer  services  whenever  the  national 
agency  may  determine  that  such  services  will  be  of  value. 

FINANCING     THE     WORK     OF     VOCATIONAL     REHABILITATION. 

Expenditures  made  specifically  for  vocational  reeducation  may  for 
the  most  part  be  covered  under  the  following  general  heads: 

1.  Cost  of  vocational  workshops  and  equipment. 

2.  Salaries  of  vocational  teachers,  supervisors,  and  directors. 

3.  Support  of  the  men  and  of  their  dependents  during  the  period 
of  their  vocational  training. 

As  a  basis  for  immediate  action  some  assumption  must  be  made 
regarding  the  proportion  of  men  requiring  vocational  training  to  the 
total  number  of  men  returned  from  overseas  unfit  for  further  mili- 
tary service.  Such  an  assumption  has  been  developed  in  estimating 
the  number  of  men  to  be  reeducated.  (See  Part  III.  The  size  of 
the  problem.) 

This  proportion  once  determined  may  be  taken  as  a  constant 
factor,  subject  to  revision  in  the  light  of  actual  developments.  The 
uncertainty  attaching  to  any  estimate  of  the  expenditures  involved 
suggests  the  need  of  great  flexibility  in  the  development  of  the  work. 
Some  general  fund  should  be  made  available  under  proper  safeguards, 
to  be  drawn  upon  in  such  amounts  as  are  required  from  time  to  time. 
This  fund  mi^ht  be  placed  in  the  custody  of  the  President  or  of  some 
board  created  by  Congress. 

In  preparing  a  budget  of  expenditure^  for  vocational  reeducation 
as  a  whole,  a  survey  should  be  made  of  the  equipment  and  service 
provided  for  vocational  reeducation  work  in  other  belligerent  coun- 
tries. An  effort  should  be  made  to  determine  so  far  as  possible  what 


22     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

specific  lines  of  vocational  training  should  be  provided  for  in  advance; 
what  methods  should  be  adopted  in  procuring  and  training  vocational 
experts  as  teachers;  and  what  expenditures  are  required  to  provide 
suitable  workshops  and  equipment.  Such  a  survey  should  be  begun 
immediately. 

Prior  to  making  such  a  survey,  however,  general  principles  of  policy 
can  be  presented,  and  these  general  principles  provide  a  clear  basis  for 
legislative  action  by  Congress  involving  appropriation  of  Federal 
money  to  the  support  of  vocational  reeducation,  and  cooperation 
with  such  public  agencies  as  States  and  municipalities,  and  with 
semipublic  and  private  agencies. 

APPROPRIATION  BY  THE  FEDERAL  GOVERNMENT. 

(a)  Provision  for  preliminary  survey  work. — Some  provision  must 
be  made  by  Congress  if  funds  are  not  available  for  this  purpose  under 
existing  legislation,  to  cover  the  preliminary  survey  work,  and  the 
general   organization    and    administration.     This    amount   will   not 
necessarily  be  very  considerable,  but  should  be  entirely  adequate, 
since  undue  economy  in  this  preliminary  work  may  mean  ultimate 
waste  of  public  money. 

(b)  Provision  for  me  conduct  of  vocational  reeducation  work* — This 
appropriation,  as  has  been  indicated  above,  should  create  a  fund 
sufficiently  large  to  cover  all  possible  eventualities  of  the  war,  and 
should  make  this  fund  available  for  expenditure  as  occasion  for  ex- 
penditure develops . 

(c)  Provision  for  support  of  men  and  their  dependents  during  tlie 
period  of  reeducation. — For  vocational  training,  in  so  far  as  it  is  con- 
ducted under  discipline  a  simple  provision  would  be  continuation  of 
military  service  pay,  together  with  support  of  dependents  during  the 
period  of  training.     Under  this  provision  the  men  should  be  reenlisted 
in  the  service  until  completion  of  their  vocational  reeducation.     This 
reenlistment  need  not  involve  extension  of  military  discipline  through- 
out the  period  of  vocational  training,  but  would  insure  the  exercise 
of  adequate  control  and  discipline,  civil  or  military,  over  the  men. 

APPROPRIATION    BY   THE    STATES. 

While  the  Federal  Government  can  not  fairly  impose  upon  the 
several  States  the  burden  of  providing  vocational  reeducation  for 
the  disabled  soldiers  and  sailors  who  were  drafted  from  that  State, 
it  is  not  improbable  that  some  of  the  States  will  voluntarily  under- 
take to  assume  a  share  of  responsibility  in  this  work. 

Under  these  conditions  the  question  arises  as  to  how  far  the  work 
may  be  paid  for  under  joint  Federal  and  State  funds. 

The  general  principle  must  be  maintained  that  adequate  provision 
must  be  made  Tor  the  training  of  every  man  disabled  in  the  military 
service  requiring  vocational  reeducation. 

A  consistent  policy  would  seem  to  involve  a  clear  definition  of 
responsibility,  as  between  the  States  and  the  Federal  Government, 
the  field  of  the  Federal  Government  being  defined  to  embrace  com- 
plete vocational  reeducation  and  reestablishment  of  the  men  in  civil 
employment.  If  in  performing  this  service  State  services  are  accepted 
it  would  seem  only  equitable  that  the  States  rendering  such  service 
should  be  completely  reimbursed  for  any  expenditures  made  by  them. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIEHS  AND  bAILOKS.     23 


will  not  exclude  the  States  from  cooperation  with,  tlie 
ial  Government,  but  will,  on  the  contrary,  open  wide  the  door 
to  such  cooperation. 

This  policy,  further,  by  relieving  the  States  of  a  specific  financial 
burden,  will  leave  them  free  to  undertake  other  services  in  behalf  of 
ret  urned  soldiers  which  can  not  be  undertaken  by  the  Federal  Gov- 
ernment, and  it  will  insure  an  equitable  distribution  of  the  burden 
upon  all  the  States. 

APPROPRIATION    BY   MUNICIPALITIES. 

In  general  the  principles  involved  in  cooperation  between  the 
Federal  Government  and  the  States  are  pertinent  to  cooperation 
with  municipalities. 

Municipalities  cooperating  in  this  work  with  the  Federal  Govern- 
ment should  be  entirely  reimbursed  by  the  Federal  Government  for 
any  expenditures  made  specifically  on  account  of  the  vocational 
reeducation  of  returned  soldiers  and  sailors,  and  should  thus  be  left 
free  to  undertake  such  other  services  in  behalf  of  these  men  as  they 
may  elect  to  do. 

CONTRIBUTIONS    BY   PRIVATE    AND    SEMIPUBLIC    AGENCIES. 

As  regards  private  and  semipublic  agencies,  such  as  the  Red  Cross, 
private  foundations,  individuals,  corporations,  trade-unions,  fraternal 
organizations,  farmers'  unions  and  granges,  hospitals,  and  schools, 
as  in  the  case  of  States  and  municipalities,  the  general  principle 
applies  that  the  Federal  Government  can  not  in  single  cases  divest 
itself  of  a  responsibility  which  it  recognizes  in  general  as  its  own.  It 
can  not  consistently  be  placed  in  the  position  of  abandoning  some 
men  requiring  vocational  training  to  the  financial  support  of  private 
or  semiprivate  agencies,  while  providing  Federal  support  in  full  for 
other  cases. 

In  fulfilling  its  obligation  to  the  disabled  soldiers  and  sailors, 
however,  the  Federal  Government  is  bound  to  accept  every  helpful 
cooperative  service  proffered  by  private  agencies.  It  may  be  an- 
ticipated that  cooperation  on  the  part  of  private  agencies  will  not 
consist  chiefly,  if  in  any  degree,  in  rendering  financial  support.  It 
might,  indeed,  be  argued  with  considerable  plausibility  that  only 
one  consideration  could  justify  acceptance  of  financial  aid  from 
private  sources  by  the  Federal  Government,  namely,  that  the  Fed- 
eral Government  might  be  financially  incapable  of  undertaking  the 
whole  support  of  the  work  under  Federal  appropriations.  Such  a 
presumption  certainly  will  not  be  permitted  by  the  American  people. 

Opportunity  for  service  to  returned  soldiers  and  sailors  is  by  no 
means  restricted  to  vocational  reeducation.  This  service  is,  in  fact, 
a  special  one  to  be  rendered  to  a  comparatively  few  men.  The 
whole  field  of  social  rehabilitation  and  readjustment  of  the  disabled 
men  returned,  and,  at  the  termination  of  the  war,  of  the  entire  body 
of  demobilized  men  returning  home,  is  open  to  private  and  semi- 
public  agencies,  and  it  may  safely  be  assumed  that  the  needs,  other 
than  those  for  vocational  reeducation,  will  be  sufficient  to  absorb 
all  available  resources. 

Foreign  practice  is  not  entirely  consistent  with  this  principle,  but 
the  present  practice  in  the  belligerent  countries  has  been  determined 


24     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILOBS. 

under  conditions  of  great  emergency  which  have  made  difficult,  if  not 
impossible,  the  consistent  development  of  any  policy.  It  may  be  no  ted, 
further,  that  traditionally  the  practice  of  certain  foreign  countries  is 
quite  different  from  our  own  as  regards  cooperation  between  public 
and  private  agencies.  In  considering  this  cooperation  the  specific 
character  of  the  several  agencies  established  and  the  social  policies 
under  which  they  operate  must  be  carefully  taken  into  account. 

NEED   FOR   TRAINING   TEACHERS   FOR   REHABILITATION.1 

The  experience  of  the  United  States  will  probably  correspond 
more  closely  to  that  of  Canada  than  to  that  of  the  other  belligerent 
countries. 

Recent  Canadian  figures  show  that  10  per  cent  of  the  men  sent 
overseas  had  been  returned  physically  unfit  for  further  military  serv- 
ice, and  that  of  these  30  per  cent  were  in  the  hospital  at  the  time  of 
the  report.  The  majority  of  these  patients  are  convalescing,  since 
men  are  not  returned  until  their  physical  condition  permits.  On  the 
basis  of  Canadian  and  of  European  experience,  it  would  appear  that  the 
United  States  may  fairly  anticipate  that  per  1,000,000  men  overseas 
100,000  will  be  returned  each  year  unfit  for  military  service,  and  that 
the  number  of  patients  constantly  in  the  hospitals  will  be  from  30,000 
to  50,000. 

The  value  of  occupational  therapy  in  the  convalescence  of  disabled 
soldiers  has  been  demonstrated  by  the  experience  of  foreign  countries 
beyond  any  possible  point  of  debate.  The  problem  for  this  country- 
is  not  whether  the  men  shall  be  given  occupational  therapy  and 
treated  along  the  most  progressive  lines  of  medicine;  it  is  rather 
the  problem  of  ascertaining  how  best  medical  treatment  and  occu- 
pational therapy  may  contribute  toward  the  ultimate  goal  of 
industrial  rehabilitation. 

The  experience  of  foreign  countries  in  rehabilitation  emphasizes 
the  necessity  of  the  recognition  of  three  fundamental  principles — 
first,  the  va«ue  of  practical  occupation ;  second,  the  importance  of 
trained  teachers,  and  third,  the  urgency  of  immediate  occupation 
in  convalescence. 

It  is  found  that  the  men  respond  far  better  to  work  of  a  practical 
type  in  the  curative  workshops  than  to  any  of  the  trivial  or  time- 
p*assing  occupations.  The  positive  danger  of  the  latter  has  been 
demonstrated  in  cases  where  the  men  have  actually  been  turned 
away  from  productive  occupations  by  following  one  of  the  "  semi- 
trades"  which  are  dependent  upon  charity  or  upon  uncertain  and 
fickle  markets  for  support.  In  Germany  there  is  no  waste  of  time 
on  useless  occupations. 

"To  employ  the  invalid  for  any  length  of  time  on  trivial  work 
does  not  seem  suitable.  It  is  much  better  to  employ  him  at  gainful 
work  as  soon  as  possible  and  to  arouse  in  him  consciousness  that  he 
is  still  able  to  perform  efficient  wTork."2  It  is  claimed  that  Germany 
uses  85  to  90  per  cent  of  her  wounded  back  of  the  lines,  and  that  only 
a  small  proportion  of  the  remainder  are  not  completely  self-supporting. 

While  the  work  is  intended  primarily  to  be  curative  lor  mind 
and  body,  experience  has  shown  that  many  men  who  have  acquired 

1  An  exhaustive  study  of  the  problem  of  rehabilitation  has  been  prepared  by  the  Federal  Board  for 
Vocational  Education  and  will  appear  in  Bulletin  No.  6. 

2  Dr.  Tjoden  in  a  lecture  given  in  Bremen. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     25 

in  the  convalescent  shops  mechanical  skill,  ability  to  interpret 
blue  prints,  a  knowledge  of  shop  arithmetic  and  mechanical  drawing, 
have  actually  increased  their  commercial  value  in  life.  In  fact, 
European  military  hospitals  have  commenced  serious  vocational 
training  in  the  hospital  workshops.  In  this  period  vocational 
training  is  given  to  the  men  as  therapeutic  discipline  and  should 
be  related  as  far  as  possible  to  their  future  occupation. 

Occupational  therapy  can  only  be  intrusted  to  those  particularly 
trained  for  it.  Work  is  prescribed  for  the  patients  by  the  doctors 
just  as  other  prescriptions  are  given.  In  order  to  avoid  harmful 
consequences,  the  work  prescription  should  be  carried  out  only  by 
one  trained  to  follow  directions  intelligently,  able  to  understand 
and  correct  mental  attitudes,  trained  to  note  fatigue,  and  compe- 
tent to  exercise  certain  muscles  and  joints.  "  French  experience 
has  established  very  clearly  that  the  selection  of  the  right  type  of 
teacher  is  vital  to  the  success  of  any  scheme  of  training  *  *  *. 
The  ideal  instructor  must  know  his  men  as  well  as  his  trade.  He 
must  study  their  peculiarities  and  be  able  to  vary  his  methods  so 
as  to  get  the  best  out  of  each  man.  The  best  possible  men  must 
be  secured  without  regard  to  cost,  and  those  wlio  fail  to  develop 
the  requisite  qualities  must  be  vigorously  weeded  out." * 

The  mental  attitude  of  the  disabled  soldier  is  such  that  if  a  delay 
occurs  before  he  is  given  an  occupation  he  frequently  becomes 
"institutionalized"  and  unable  to  adapt  himself  to  the  idea  of  pro- 
ductive work.  Experience  has  amply  proved  that  the  ease  with 
which  men  become  adjusted  and  employable  is  in  direct  ratio  to  the 
promptness  with  which  reeducation  is  begun. 

"The  question  is  desperately  urgent.  Habits  of  idleness  are  not 
easily  shaken  off,  and  if  once  these  men  are  allowed  to  sink  into 
despondency  and  apathy  they  will  soon  degenerate  into  chronic 
unemployables.  *  *  *  Delay  means  wasted  lives."1  French 
figures  show  that  only  5  per  cent  of  the  men  took  up  training  if  it 
was  delayed  until  after  hospital  discharge,  whereas  80  per  cent  con- 
tinued training  if  begun  in  the  hospitals. 

The  necessity  of  providing  teachers  of  occupational  therapy  is 
imperative.  Canada  provides  four  teachers  for  every  hundred 
convalescing  patients,  and  anticipates  increasing  the  number  of 
teachers  per  hundred  patients. 

On  an  estimate  of  four  teachers  for  every  hundred  men  this 
country  will  have  to  provide  1, 200  trained  occupational  thera- 
peutists for  every  million  men  overseas.  There  is  at  present  a  very 
limited  number  of  competent  occupational  therapeutists,  and  far 
from  adequate  courses  of  training,  equipment,  and  hospital  facilities 
exist  for  training  more. 

In  order  to  meet  this  emergency,  the  Federal  Board  for  Vocational 
Education  has  made  a  special  study  of  the  problem  of  training 
teachers  for  the  curative  workshop,  taking  into  consideration  the 
cooperation  which  must  exist  between  the  medical  authorities  and 
the  vocational  officer  in  directing  the  patient  from  the  earliest  mo- 
ment toward  an  occupation  in  which  his  handicap  may  be  reduced 
to  the  minimum  and  his  facility  developed  to  the  maximum.  This 
study  is  based  upon  the  probable  numbers  of  teachers  required, 

1  L.  G.  Brock,  American  Journal  of  Care  for  Cripples,  vol.  4,  no.  1. 


28     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIEES  AND  SAILORS. 

special  problems  encountered  in  dealing  with  war  invalids,  necessary 
background  to  carry  out  the  physician's  instructions  intelligently, 
and  qualifications  of  instructors  and  courses  of  teacher  training. 

Upon,  discharge  from  the  hospital,  80  per  cent  of  the  men,  accord- 
ing to  Canadian  figures,  are  able  to  return  to  their  former  occupa- 
tions. Ten  per  cent  need  corcmlete  vocational  reeducation  and 
10  per  cent  partial  vocational  reeducation.  ^The  difficult  problem 
of  securing  teachers  for  vocational  education  is  only  equaled  by  the 
scarcity  01  occupational  therapeutists. 

In  addition  to  the  requirements  of  the  regular  vocational  instruc- 
tor, the  instructor  of  the  disabled  soldier  must  know  those  points  of 
difference  between  his  soldier  pupils  and  the  normal  pupils  to  whom 
he  is  accustomed.  The  shop  instructor,  even  more  than  the  instruc- 
tor of  related  or  academic  subjects,  must  be  highly  skilled  in  his 
trade  for  the  reason  that  many  of  the  men  will  have  had  experience 
in  that  trade,  and  unlike  the  raw  youth  in  vocational  classes,  they 
will  be  critical,  and  unwilling  to  learn  from  one  not  markedly  their 
superior.  As  a  rule  the  boys  of  vocational  education  age  are  eager, 
quick,  and  teachable,  whereas  many  of  the  returned  soldiers,  though 
young  enough  to  have  receptive  minds,  are  of  maturer  age.  The 
fact  that  they  have  been  returned  unfit  for  further  military  service 
indicates  that  in  some  way,  either  by  lessened  vitality  or  permanent 
handicap,  they  are  below  par.  Moreover,  the  experience  of  war  has 
been  a  mentally  paralyzing  experience,  and  the  instructor  must  be 
patient  and  must  understand  his  pupil.  In  addition  to  intelligent 
sympathy,  the  instructor  must  maintain  regularity  and  meet  the 
requirements  of  the  vocational  school,  for  vocational  education 
leads  directly  to  employ  ability.  The  patients  do  not  enter  the  voca- 
tional classes  until  the  medical  authorities  have  discharged  them  or 
else  state  that  their  physical  condition  will  permit  a  regular  course  of 
study. 

The  best  vocational  instructors  must  be  selected  for  training  the 
disabled  patients,  not  only  because  they  require  the  best  possible 
instruction,  but  because  the  problem  of  teaching  them  is  particularly 
difficult  and  important. 

NEED    FOE    EARLY    ENACTMENT   OF    LEGISLATION. 

The  rehabilitation  of  disabled  soldiers  and  sailors  is  a  task  so 
important,  so  large,  so  complicated,  and,  therefore,  so  difficult,  that 
Congress  should,  at  the  earliest  possible  moment,  provide  by  legisla- 
tion a  clear  and  definite  plan  for  the  organization,  administration, 
and  support  of  the  work. 

Although  the  United  States  has  been  at  war  more  than  hah0  a  year, 
no  specific  appropriation  has  yet  been  made  by  Congress  for  establish- 
ing and  operating  vocational  training  for  men  handicapped  by  war. 
Indeed,  no  such  appropriation  has  been  made  even  for  the  proper 
study  and  investigation  of  the  many  problems  involved. 

It  is  true  that  section  304  of  the  war-risk  insurance  bill  (Public, 
No.  9,  Sixty-fifth  Congress— H.  R.  5723),  which  became  a  law 
October  6,  1917,  apparently  places  the  work  of  rehabilitation,  reedu- 
cation, and  vocational  trainingfor  disabled  men  in  the  hands  of  the 
Director  of  the  Bureau  of  War-Risk  Insurance,  who,  under  the 
Treasury  Department,  has  the  duty  and  responsibility  of  administer- 
ing the  entire  act. 


VOCATIONAL  JREilABlLli  AT10N  OF  DISABLED  SOLDIERS  AND  SAILORS.     27 

follows: 

Tluit  in  cases  of  dismemberineiit,  of  injuries  to  sight  or  hearing,  and  of  other  injuries 
commonly  causing  permanent  disability,  the  injured  person  shall  follow  si.'  ii  course 
or  courses  of  rehabilitation,  reeducation,  and  vocational  training  us  11; 
may  provide  or  procure  to  be  provided.  Should  such  course  prevent  the  injured 
person  from  following  substantially  gainful  occupation  while  taking  same,  a  Win.  of 
enlistment  may  be  required  which  shall  bring  the  injured,  person  into  the  military 
or  naval  service.  Such  enlistment  shall  entitle  the  person  to  full  pay  as  dun: 

n>nth  of  his  active  service,  and  his  family  allowances  and  allotment  as  herein- 
before provided,  in  lieu  of  all  other  compensation  for  the  time  being. 

In  case  of  his  willful  failure  properly  to  follow  such  course  or  so  to  enlist,  payment 
of  compensation  shall  be  suspended  until  such  willful  failure  ceases  and  no  compensa- 
tion shall  be  payable  for  the  intervening  period. 

For  reasons  discussed  below  this  section  has  remained  inoperative. 
Indeed,  the  section  is  more  a  promise  of  what  should  be  done  than  a 
workable  program  for  the  vocational  rehabilitation  and  the  return  to 
civil  employment  of  disabled  soldiers  aiid  sailors. 

Section  304  of  the  war-risk  insurance  act  makes  no  appropriation 
to  meet  the  expense  of  carrying  on  the  course  or  courses  for  tho 
rehabilitation  and  vocational  training  promised  by  that  section. 
All  the  appropriations  are  for  insurance,  compensation,  allowances, 
funeral  expenses,  and  similar  items;  none  are  for  rehabilitation,  re- 
education, and  training.  Without  additional  legislation  Congress  is 
placed  in  the  position  of  having  made  a  promise  to  enlisted  men 
without  providing  a  dollar  to  carry  it  out.  Outside  of  a  small 
part  of  the  $100,000  appropriated  for  the  administration  of  the 
war-risk  insurance  which  might  possibly  be  used  for  section  304 
(though  in  what  way  is  not  clear),  the  section  is  meaningless  for 
want  of  funds.  This  has  doubtless  caused  a  delay  when  every 
consideration  demands  immediate  planning  for  action.  Otherwise 
this  great  national  duty  and  exigency  will  be  left  to  private  philan- 
thropy and  control,  a  procedure  which  has  met  with  signal  failure 
among  the  allies. 

Section  304  is  buried  in  an  act,  every  one  of  whose  other  important 
sections  deals  with  war-risk  insurance.  Admittedly  it  was  inserted 
as  a  promise  by  Congress  that  the  rehabilitation,  reeducation,  and 
vocational  training  of  injured  soldiers  and  sailors  would  be  more 
dclinitely  provided  for  at  the  ensuing  session.  Naturally,  under 
these  circumstances,  this  very  difficult  and  highly  specialized  work 
is  committed,  under  the  general  terms  of  the  act  to  an  organization 
and  administration,  which,  while  admirably  adapted  for  war-risk 
insurance — for  which  it  was  primarily  intended — is  inadequate,  so  far 
as  section  304  is  concerned,  for  the  proper  care,  education,  and  place- 
ment in  industry  of  injured  men. 

Furthermore,  very  grave  uncertainty  exists  from  the  legal  stand- 
point as  to  duties,  powers,  and  relationships  between  the  Treasury 
and  the  War  and  Navy  Departments  in  dealing  with  this  problem  of 
vocational  rehabilitation.  On  the  one  hand,  the  War-Risk  Insurance 
Bureau  of  the  Treasury  Department  is  charged  with  the  duty  of 
administering  the  compensation  and  annuities  for  disabled  men,  a 
task  which  involves,  of  course,  dealing  with  them  almost  from  the 
time  they  receive  their  injuries.  On  the  other  hand,  the  Surgeon 


28     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

Generals'  offices  of  the  War  and  of  the  Navy  Departments  have  tra- 
ditionally dealt  with  the  surgery,  the  medical  care,  and  the  functional 
rehabilitation  of  injured  men. 

While  funds  in  the  hands  of  the  Secretary  of  War  under  liberal 
appropriations  made  by  Congress  have  been  appropriated  for  the 
hospital  and  medical  care  of  wounded  men,  the  use  of  these  funds 
for  vocational  reeducation  has  not  been  specifically  granted.  There- 
fore, if  these  funds  are  so  used  it  must  be  under  the  broad  assumption 
either  that  vocational  rehabilitation  is  a  part  of  functional  rehabilita- 
tion or  that  the  wounded  man  is  still  enlisted  and  that  this  training 
is  a  part  of  his  discipline  as  an  enlisted  man.  There  seems  to  have 
been  no  agreement  up  to  this  time  at  least  between  the  Treasury 
Department,  the  War  Department,  and  the  Navy  Department  as  to 
their  respective  authority  and  responsibility  under  existing  legisla- 
tion or  as  to  how  they  can  effectively  cooperate.  Under  these  cir- 
cumstances, every  consideration  requires  the  early  enactment  of 
legislation  designed  to  relieve  present  uncertainty  and  to  provide 
ample  funds  for  entering  with  certainty  and  speed  upon  the  study, 
planning,  and  execution  of  a  comprehensive  scheme  for  the  care, 
rehabilitation,  and  reemployment  of  the  victims  of  this  war. 

CONFERENCE  TO  FORMULATE  A  COMPREHENSIVE  PLAN  OF 
REHABILITATION. 

Because  of  the  widespread  interest  and  the  uncertainty  as  to  the 
final  program  which  Congress  will  establish,  different  departments 
and  branches  of  the  Government,  as  well  as  private  organizations, 
have  been  studying  the  problem  and  making  tentative  plans  to  meet 
it.  To  prevent  confusion  and  the  development  of  many  separate 
and  duplicating  efforts  the  Surgeon  General  of  the  Army,  at  the 
suggestion  of  the  Secretary  of  War,  recently  called  together  in  con- 
ference representatives  from  the  Departments  of  the  Treasury,  War, 
Navy,  Interior,  and  Labor,  the  Federal  Board  for  Vocational  Edu- 
cation, the  Public  Health  Service,  the  United  States  Employees7 
Compensation  Commission,  the  Council  of  National  Defense,  the 
National  Chamber  of  Commerce,  the  division  for  civilian  relief  of 
the  Red  Cross,  the  National  Manufacturers'  Association,  and  the 
American  Federation  of  Labor  to  give  full  consideration  to  the 
problem  and  to  formulate  a  definite  and  comprehensive  plan  which 
would  provide  a  continuous  process  for  the  physical  and  mental 
restoration  of  disabled  soldiers  and  sailors  and  their  vocational 
rehabilitation  and  return  to  civil  employment. 

In  order  to  be  of  the  largest  assistance,  this  conference  terminated 
its  labors  by  the  adoption  of  a  tentative  bill  embodying  the  principles 
and  policies  of  which  the  conference  approved.  This  measure  was 
respectfully  submitted,  through  the  Surgeon  General,  to  the  Secretary 
of  War  for  his  consideration,  with  the  recommendation  that  after  it 
had  passed  through  the  hands  of  the  solicitors  of  the  departments  con- 
cerned for  the  correction  of  such  technical  defects  as  the  proper 
description  of  ail  the  beneficiaries  to  be  reached  by  the  measure, 
the  same  should  be  presented  to  the  Congress  for  its  consideration. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     29 
LEGISLATION    MUST    BE    BROAD    AND    FLEXIBLE. 

No  more  difficult  problem  was  ever  presented  to  a  people  than  the 
sacred  task  of  restoring  the  victims  of  this  great  conflict  to  normal 
life  and  happy,  self-dependent  employment. 

It  is  not  known  how  long  the  war  will  last ;  how  many  soldiers 
will  be  sent  to  Europe;  how  many  will  be  injured;  how  many 
will  die;  how  many  will  return  totally  disabled;  how  many  will  be 
subjects  for  vocational  rehabilitation;  what  means  of  employment 
will  be  open  and  to  what  extent;  what  the  character  of  injuries  will 
be;  what  forms  of  employment  will  be  advisable  for  men  returning, 
as  is  usual,  with  a  complication  of  disabilities;  how  they  may  be  best 
trained;  where  and  how  they  should  be  placed;  what  will  be  the 
economic  conditions  during  and  after  the  war;  what  Government  and 
civic  employments  will  be  open;  what  cooperation  can  be  secured 
from  the  States,  employers,  organizations  of  employers,  private 
foundations,  institutions,  and  philanthropic  foundations;  what  will 
be  the  cost  of  carrying  on  the  work;  how  this  cost  is  to  be  distributed 
during  the  years  the  work  is  being  carried  on;  and  what  social  and 
economic  adjustment  must  be  faced. 

Any  legislation  dealing  with  this  question  must  be  broad  and  flexi- 
ble. Experience  of  foreign  governments  has  shown  not  only  that 
the  support  and  control  of  rehabilitation  must  be  in  the  hands  of  the 
National  Government,  but  that  the  work  itself  must  be  done  by  a 
national  board  equipped  with  ample  funds  and  having  broad  dis- 
cretionary powers,  designed  to  meet  the  rapidly  changing  conditions 
in  the  conduct  of  the  war  and  to  coyer  the  growing  experience  of  the 
country  in  dealing  with  the  reeducation  and  placement  of  handicapped 
men. 

This  national  board  should  be  a  board  already  in  existence,  desig- 
nated because  of  its  experience  and  facilities  for  the  administration 
of  vocational  training  and  because  of  the  representative  character 
of  its  membership.  If  a  new  board  should  be  created  by  Congress 
for  the  purpose,  all  existing  facilities  for  the  study  and  administra- 
tion of  vocational  education  now  possessed  by  the  National  Gov- 
ernment should  be  recognized  and.  utilized,  so  as  to  avoid  confusion, 
overlap  and  duplication  of  effort,  and  needless  expense. 


PART  II. 
FOREIGN  LEGISLATION  AND  EXPERIENCE. 

COORDINATION  AND  CENTRALIZATION  OF  AUTHORITY. 

In  each  of  the  belligerent  countries  experience  has  demonstrated 
that  the  process  of  returning  men  incapacitated  for  further  military 
service  to  civil  employment  must  be  a  continuous  process,  initiated 
in  the  hospital  and  continued  without  break  through  the  various 
stages  of  convalescence,  vocational  reeducation,  placement,  and  pro- 
ductive emplovmeiit  in  the  workshop. 

Any  break  in  this  process  may,  in  individual  cases,  mean  failure 
and  permanent  dependency,  and  is  certain  to  mean  in  general  in- 
creased expenditure  and  effort.  Once  the  disabled  soldier  or  sailor 
has  drifted  into  unskilled  casual  employment,  or  into  a  state  of  de- 
pendency, his  economic  rehabilitation  becomes  exceedingly  difficult. 

Each  belligerent  has  accordingly  made  legislative  provision  which 
insures  the  immediate  and  direct  return  of  invalided  soldiers  and 
sailors,  either  to  their  old  employment,  if  they  are  capable  of  under- 
taking it,  or  to  some  new  employment  for  which  their  handicap  does 
not  constitute  a  prohibitive  bar.  Under  this  legislation  such  voca- 
tional training  in  the  old  or  in  a  new  employment  is  given  each  man 
as  he  may  require.  This  training  is  given  in  hospital  workshops 
during  convalescence,  in  classes  and  schools  specially  organized  for 
disabled  soldiers  and  sailors,  in  technical,  trade  and  agricultural 
schools,  and  in  factories  and  workshops  under  special  agreements 
with  employers. 

A  great  variety  of  agencies,  public  and  private,  cooperate  in  this 
work  of  reestablishing  men  in  civil  employment  under  fair  guarantees 
as  regards  wages,  hours,  and  every  condition  of  work. 

During  the  first  mouths  of  the  war,  however,  each  of  these  agencies 
worked  ^more  or  less  ^ independently  of  the  others,  rendering  such 
service  in  behalf  of  disabled  men  as  it  was  capable  of  rendering  in 
the  face  of  the  sudden  emergency  imposed  by  the  war,  and  these 
early  efforts  were  necessarily  uncoordinated  and  disparate. 

The  development  in  each  country  during  the  war  may  be  summed 
up  in  the  words  coordination  of  effort  under  a  central  agency  of 
national  administration  embracing  a  great  diversity  of  agencies  and 
resources. 

In  England,  for  example,  the  agency  of  centralized  authority  is 
the  special  grants  committee  under  the  minister  of  pensions;  in 
France,  it  is  the  ' l  office  national  des  mu tiles  et  reformes  de  la  guerre  "; 
in  Italy,  the  national  committee  for  the  protection  and  help  of  men 
invalided  in  the  war;  and  in  Canada,  the  military  hospitals  com- 
mission. 

Under  the  general  direction  of  these  national  agencies  of  control  a 
great  diversity  of  effort  has  been  coordinated,  and  every  available 

31 


32     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AXD  SAILORS. 

resource,  public  and  private,  is  effectively  utilized  in  a  general  scheme 
of  cooperation  administratively  financed  by  the  central  government, 
which  also  provides  such  funds  as  are  required  for  maintenance  of 
vocational  training,  and  for  support  of  the  men  and  of  their  depend- 
ents during  the  period  of  their  training. 

In  the  following  sections,  based  upon  such  official  and  unofficial 
sources  of  information  as  are  available,  brief  accounts  are  given  of 
the  legislation  which  has  been  enacted  in  the  several  belligerent 
countries,  and  of  the  various  agencies  which  have  been  developed 
and  coordinated  under  this  legislation. 

ENGLAND. 
NAVAL  AND  MILITARY  WAR-PENSIONS  ACT  OF  1915. 

The  naval  and  military  war  pensions  act  of  November,  1915,  was 
passed  by  Parliament  following  recommendations  by  a  committee 
under  the  chairmanship  of  Sir  George  Murray. 

This  committee,  which  had  been  previously  appointed  to  investi- 
gate the  best  methods  of  caring  for  disabled  men  discharged  from 
the  army,  had  in  its  report  recommended  that  the  work  of  caring  for 
such  men  be  devolved  upon  a  central  authority. 

In  the  war  pensions  act  of  1915,  "the  State  for  the  first  time  recog- 
nized its  responsibility  for  the  treatment  and  care  of  disabled  soldiers 
after  then1  discharge  from  the  Army."  1  In  England  the  royal  patri- 
otic fund  corporation,  dating  back  to  the  Crimean  War,  had  admin- 
istered in  trust  charitable  funds  for  disabled  soldiers,  and  soldiers' 
widows  and  orphans,  but  it  seems  to  have  become  apparent,  at  the 
very  outset  of  the  present  war  in  England,  as  in  France,  that  private 
funds  would  prove  inadequate  for  this  work.  The  war  pension  act  of 
1915  recognized  the  necessity  for  State  support  in  the  discharge  of 
an  obligation  resting  clearly  upon  the  whole  community. 

By  the  terms  of  the  act  the  royal  patriotic  fund  corporation  was 
constituted  a  statutory  committee  consisting  of  27  members.  This 
committee  was  given  authority  "to  make  provision  for  the  care  of 
disabled  officers  and  men  after  they  have  left  the  service,  including 
provision  for  their  health,  training,  and  employment." 

Vocational  reeducation  and  placement  of  disabled  men  after  dis- 
charge from  the  Army  is  thus  generally  specified  as  falling  within  the 
scope  of  the  functions  of  the  statutory  committee,  which  is  left  en- 
tirely free  to  develop  the  work  in  its  discretion  and  according  to  the 
resources  available. 

In  the  provisions  of  this  act  is  found  "the  germ  of  the  State  system 
of  training  to  enable  those  who  have  suffered  directly  through  the 
war  to  resume  their  civil  occupation."  It  was  pointed  out,  however, 
that  the  duty  of  the  committee  "was  not  so  much  to  supplant  private 
institutions  for  the  care  and  training  of  the  disabled  as  to  coordinate 
them,  and  only  when  necessary  to  supplement  them,"  utilizing  to 
the  full  all  existing  organizations  of  the  State,  such  as,  for  example, 
''the  education  department,  the  health  insurance  commission,  and 
the  labor  exchange."  The  statutory  committee  is  described  as  "more 
a  coordinate  and  advisory  body  than  an  administrative  department." 

i  Capt.  Basil  Williams,  Care  of  crippled  and  blinded  soldiers  in  Great  Britain;  article  in  Recalled  to  Life, 
reprinted  in  American  Journal  of  Care  for  Cripples  of  September,  1917,  p.  97. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     33 

The  central  committee  was  instructed  by  the  act  to  establish  local 
committees,  one  from  each  county  or  county  borough,  and  one  for 
each  borough  and  urban  district  01  not  less  than  50,000  population, 
whose  council  so  desired,  and  one  for  every  other  borough  or  urban 
district  for  which  the  statutory  committee,  on  the  application  of  the 
local  council,  -considered  it  aesirable  that  a  separate1  local  com- 
mittee should  be  established. 

These  local  committees  were  to  perform  their  functions  under 
schemes 1  to  be  adopted  by,  and  so  far  as  seemed  advisable,  devised 
by  the  local  councils  and  approved  by  the  statutory  committee. 
Such  schemes  might  in  any  given  case  provide  for  the  division  of  a 
county  into  districts  and  the  appointment  of  a  subcommittee  in  each 
district.  Thus  considerable  responsibility  and  discretion  was  to  be 
delegated  to  the  local  committees. 

The  members  of  the  central  committee  were  appointed  by  the 
Crown,  the  royal  patriotic  fund  corporation,  the  war  office,  the 
Admiralty,  and  other  Government  offices,  and  the  Soldiers'  and  Sail- 
ors' Families'  Association.  The  central  committee  itself  was  in- 
structed to  appoint  a  subcommittee,  which  should  include  in  its 
membership  representatives  of  employers  and  of  labor,  and  local 
district  committees  might  appoint  similar  subcommittees. 

The  central  committee  and  the  local  committees  were  authorized 
to  solicit  and  receive  contributions  from  the  public,  and  Parliament 
voted  to  the  central  committee  £1,000,000.  Funds  subscribed  locally 
might  be  expended  by  the  local  committee,  which  might  refer  in- 
dividual cases  to  the  central  committee  for  assistance  to  be  given  out 
of  funds  at  the  disposal  of  this  committee. 

It  was  provided  that  administrative  expenses  of  local  committees 
and  subcommittees  shall  be  defrayed  by  the  council  of  the  county  or 
borough. 

The  following  brief  account  of  developments  under  this  act  is 
taken  largely  from  the  article  cited  above  by  Capt.  Basil  Williams. 

AVORK    OF   THE    STATUTORY    COMMITTEE. 

The  statutory  committee  investigated  the  work  being  done  by  the 
education  department,  the  board  of  trade's  employment  bureau,  the 
health  insurance  commissions,  the  war  office,  and  the  Admiralty, 
and  by  a  large  number  of  voluntary  private  agencies,  such  as  the 
lied  Cross,  and  the  St.  John's  ambulance  societies. 

It  undertook  to  guide  the  extension  of  activities  of  these  several 
agencies  so  as  to  provide  needed  services  and  avoid  misdirection  and 
waste  of  resources. 

1  The  following  outline  of  a  scheme  was  submitted  under  the  naval  and  military  \var  pensions  act  by  the 
statutory  committee  for  adoption  by  local  committt  • 

Scheme  framed  by  the County  Council  for  the  constitution  of  a  local  committee  for  the  county  of 

,  excluding  the  royal  parliamentary  or  police  burghs  of . 

1.  Constitution  ot local  committee.   Stated  number  to  be  women,  representatives  of  labor,  and  members 
of  the  Soldiers'  and  Sailors'  Families'  Association,  or  the  Soldiers'  and  Sailors'  Help  Society,  or  any 
other  association  doing  work  of  this  kind. 

2.  The  members  to  be  appointed  by  county  council. 

3.  Term  of  office  to  be  three  years. 

4.  Regulation  regarding  absence  of  members. 

5.  Regulation  regarding  casual  vacancies. 

6.  Settlement  of  differences  to  be  by  statutory  committee. 

7.  Vacancies  not  to  invalidate  proceedings. 

s.  Chairman  and  vice  chairman  to  be  appointed  by  the  committee. 

9.  Time  and  place  of  meetings  to  be  held  at  stated  intervals. 

10.  Procedure  to  be  regulated  by  committee. 

11.  Duration  of  scheme  to  be  in  power  of  Ilie  council  with  consent  of  the  statutory  committee. 
Schemes  for  boroughs  have  practically  the  same  form. 

42297°— S.  Doc.  166,  65—2 3 


34  .  VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

It  undertook  also  to  encourage  the  institution  of  such  new  agencies 
as  were  required,  "  thence  to  evolve  a  coordinated  system  which 
would  insure  that  every  case  of  disablement  should  be  able  to  obtain 
adequate  treatment,  training,  and  employment,  if  possible  within 
convenient  distance  of  a  man's  home." 

The  statutory  committee  had  power  to  pay  allowances  to  men 
during  the  period  of  their  vocational  training,  and  to  pav  fees 
charged  for  such  training  in  institutions  giving  it,  all  this  on  the 
basis  of  consideration  of  individual  cases. 

The  following  extracts  are  from  regulations  and  instructions 
published  by  the  statutory  committee: 

TEMPORARY    ALLOWANCE. 

In  the  case  of  a  soldier  or  sailor  discharged  as  disabled  in  consequence  of  the  present 
war,  where  the  local  committee  are  satisfied  that  the  man  is  either  entitled  to  a  dis- 
ability pension  from  the  State  or  would  be  recommended  for  a  special  allowance  of  a 
continuing  nature  from  the  statutory  committee,  and  where,  in  the  opinion  of  the  local 
special  subcommittee,  it  would  be  advisable  for  such  sailor  or  soldier  to  receive  train- 
ing in  a  technical  institute,  jwlytechnic  or  similar  institution  before  using  his  earn- 
ing capacity,  the  local  committee  may  pay  the  fees  charged  in  respect  of  such  tech- 
nical training  to  an  institution  maintained  or  aided  by  a  local  authority  or  other 
recognized  place  of  training  approved  by  the  statutory  committee  for  this  purpose, 
and  may  make  a  temporary  allowance  to  the  disabled  man  during  the  period  of  his 
training  sufficient  to  make  up  his  income  including  State  pension  or  State  temporary 
allowance  and  other  income  (if  any). 

In  the  case  of  a  single  man  to  not  exceeding  25s.  a  week. 

In  case  of  a  married  man. living  at  home,  to  25s.  a  week,  together  with  2s  6d.  for 
each  child. 

Or,  if  more  favorable  to  the  man,  a  temporary  allowance  of  a  sum  in  addition  to  his 
income  equivalent  to  the  loss,  owing  to  his  entry  into  training,  or  actual  earnings  or 
earning  capacity,  assumed  for  the  purpose  of  the  State  pension  or  any  supplementary 
pension,  whichever  be  greater.  And  where  such  training  necessitates  a  married  man 
or  a  single  man  with  dependents  living  away  from  home,  a  temporary  allowance 
sufficient  to  make  up  his  income,  including  State  pension  or  State  temporary  allow- 
ance and  other  income  (if  any),  to  not  exceeding  25s.  a  week  for  the  man  himself, 
together  with  an  amount  for  his  wife  or  dependents  (a)  where  such  training  commences 
before  the  State  separation  allowance  ceases  equal  to  such  allowance  including  allot- 
ment, plus  any  supplementary  separation  allowance  receive'd  by  the  wife  or  depen- 
dents under  the  Regulations  or  any  Treasury  grant;  or  (6)  where  such  training  com- 
mences after  the  cessation  of  the  State  separation  allowance  sufficient  to  make  up  for 
the  loss  owing  to  his  entry  into  training,  of  actual  earnings  or  earning  capacity  assumed 
for  the  purpose  of  the  State  pension  or  any  supplementary  pension,  whichever  be 
greater,  less  such  amount  as  may  be  saved  in  respect  of  the  man's  keep.  Any  part  of 
the  allowance  in  such  cases  may,  by  arrangement  with  the  man,  be  paid  to  his  wife 
or  dependents  or  to  any  hostel  or  institution  where  he  is  maintained. 

Provided,  That  any^  wages  paid  to  the  man  for  service  rendered  during  the  regular 
hours  of  training  or  instruction  shall  be  regarded  as  "other  income"  and  deducted 
from  the  allowance  otherwise  payable  under  this  regulation. 

Any  scheme  for  training  must  be  sanctioned  by  the  statutory  committee  before 
any  allowance  is  made  thereunder,  and  no  allowance  for  training  shall  be  paid  to  a 
man  for  more  than  26  weeks  without  the  like  sanction. 

******  * 

Local  committees  will,  at  the  same  time,  recognize  that  there  are  other  ways  of 
assisting  a  case  than  by  the  grant  or  continuance  of  a  supplementary  pension  or  special 
allowance.  In  the  case  of  disabled  men  special  provision  can  be  made 

under  the  act  for  their  health,  training,  and  employment. 

******* 

In  cases  where  sailors  or  soldiers  are  discharged  partially  disabled,  they  receive 
pensions  calculated  on  the  proportion  of  the  man's  earning  capacity  which  is  assumed 
to  have  been  destroyed.  Earning  capacity  for  this  purpose  is  taken  at  the  flat  rate  of 
25s.,  and  the  weekly  pension  awarded  is  a  proportion  of  25s.,  according  to  the  degree 
of  incapacity.  The  same  proportion  is  applied  to  the  allowance  of  2s.  6d.  for  each 
child. 


.VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     35 

It  is  recognized  that  the  obligations  of  the  community,  to  men  whose  health  and 
earning  powers  have  been  impaired  by  their  service,  are  not  satisfied  merely  by  the 
grant  of  pension  but  that  they  are  entitled  to  such  training  or  continued  treatment 
as  will  restore  to  them,  BO  far  as  possible,  their  normal  health  and  earning  powers. 

It  is  hoped  that  men  will  be  ready  to  take  advantage  of  the  arrangements  made  by 
local  committees,  with  the  approval  of  the  statutory  committee,  for  their  training  and 
treatment,  but  it  is  probable  that  it  may  be  difficult,  in  many  cases,  particularly  of 
men  of  mature  age,  to  persuade  them  to  do  so.  The  aim  of  the  statutory  committee 
in  framing  regulation.  12  has,  therefore,  been  to  provide  for  adequate  financial  assist- 
ance for  those  men  who  are  willing  to  undergo  training  or  treatment,  and  the  alter- 
natives in  the  regulation  are  inserted  in  order  that  in  no  case  shall  a  man,  while  being 
trained  or  under  treatment,  be  in  a  worse  financial  position  than  if  he  had  remained 
at  home. 

In  the  case  of  a  man  who  undergoes  training,  and  is  able  to  live  at  home  during  such 

training,  subhead  (a]  authorizes  the  local  committee  to  make  up  his  income  to  not 

exceeding  25s.  a  week  in  the  case  of  a  single  man,  and  to  not  exceeding  25s.  plus  2s.  6d. 

k  for  each  child  if  he  is  married,  or  if  more  favorable'  to  the  man,  they  may  grant 

hinr  an  allowance  not  exceeding — 

(a)  The  amount  of  his  earnings  immediately  prior  to  his  training;  or 

(b)  The  amount  which  the  State  or  the  statutory  committee  assumed  that  he  was 
capable  of  earning  for  the  purpose  of  assessing  State  pension  or  supplementary  pension, 
respectively. 

The  same  provisions  will  apply  to  a  single  man  without  dependents  whose  training 
necessitates  his  living  away  from  home,  but  a  single  man  with  dependents,  or  a  married 
man  may  be  granted,  in  such  circumstances,  a  temporary  allowance  sufficient  to  make 
up  his  income,  including  State  pension  or  temporary  allowance  and  any  other  income, 
to  not  exceeding  25s.  by  way  of  maintenance  for  himself,  together  with — 

(c)  The  amount  of  State  separation  allowance,  allotment,  and  any  supplementary 
separation  allowance  from  the  statutory  committee  or  grant  from  the  military  service 
(civil  liabilities)  committee  received  by  his  wife  or  dependents  during  his  service;  or 

(d)  The  amount  of  the  loss  owing  to  his  entry  into  training  as  set  out  under  (a)  or 
(6)  above  less  the  amount  of  the  saving  resulting  from  his  absence. 

Pro-vi^ed,  That  an  allowance  on  basis  (c)  must  only  be  applied  where  a  man  enters 
upon  his  training  before  cessation  of  State  separation  allowance. 

In  April,  1917,  the  war  pensions  and  statutory  committee  issued 
a  circular  of  instruction  declaring  that  when  a  local  special  sub- 
committee had  decided  that  it  would  be  advisable  for  a  disabled 
soldier  or  sailor  to  undergo  training  or  treatment,  and  the  training 
or  treatment  can  not  be  entered  upon  at  once  on  account  of  want 
of  accommodations  in  a  suitable  institution  or  for  other  exceptional 
circumstances,  the  local  committee  may  apply  regulation  12  giv- 
ing temporary  allowance  on  the  same  basis  as  for  a  man  receiving 
training  or  treatment.1 

HOSPITAL   DISCHARGES. 

A  large  proportion  of  the  men  discharged  from  the  military  hos- 
pitals are  fit  to  resume  their  military  service  and  return  to  the  army. 
Statistics  for  one  hospital  covering  discharges  for  one  year  showed 
that  out  of  1,350  orthopedic  cases — that  is  to  say,  out  of  1,350  cases 
involving  "some  form  of  disability" — 997  were  returned  to  the 
army,  leaving  only  353  cases  discharged  as  permanently  unfit  for 
further  military  service.  These  latter  cases  come  immediately  under 
care  of  the  local  committees  for  further  treatment,  vocational  train- 
ing, and  placement  in  a  wage-earning  employment. 

An  interval  of  three  weeks  intervenes  between  the  time  when  the 
man's  hospital  treatment  is  regarded  as  complete  and  his  discharge 
Jrom  the  hospital. 

i  Circular  No.  39,  dated  Apr.  28. 1917. entitled  "Additional  instruction  to  Part  II,  regulation  12." 


36     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

In  this  interval  the  man  is  interviewed  by  a  member  of  the  local 
committee  of  the  community  in  which  the  hospital  is  located,  and  all 
particulars  of  his  case  are  taken  down,  including  previous  occupation 
and  occupational  preferences. 

These  particulars  are  forwarded  to  the  local  committee  of  the 
man's  home  community.  It  then  becomes  the  duty  of  the  homo  com* 
mittee  to  take  the  initiative  in  providing  for  the  man  on  his  discharge 
from  the  hospital  and  return  to  his  domicile. 

In  this  three- weeks  interval,  also  a  " treatment  card"  is  filled  out 
by  the  medical  officer  in  charge  of  the  hospital,  specifying  further 
curative  treatment  recommended.  This  card  is  forwarded  to  the 
home  local  committee  and  a  copy  is  given  to  the  man  himself. 

PROVISION    FOR    REEDUCATION. 

Every  effort  is  made  to  inform  the  man — as,  for  example,  by 
posters  displayed  in  the  hospital  wards,  stations,  and  public  places — 
of  opportunities  open  to  him  for  securing  further  treatment,  and 
vocational  training. 

At  many  of  the  orthopedic  hospitals  training  classes  for  men 
under  treatment  have  been  established  by  technical  institutes 
in  such  lines  as  typewriting,  woodworking,  leather  embossing,  metal 
lathe  work,  telegraphy,  cinema  operation,  cobbling,  painting,  and 
gardening. 

In  other  cases,  classes  are  given  in  neighboring  institutes  in  such 
lines  as  bakery  and  confectionery,  electrical  switchboard  work, 
bootmaking  and  repairing,  leather  work,  agriculture,  and  motor 
plowing,  engineering,  tinsmithing,  and  coppersmi thing. 

In  some  cases  private  employers  offer  to  give  disabled  men  an 
apprenticeship  in  their  workshops.1 

The  ministry  of  munitions  has  opened  its  advanced  courses  in 
toolmaking,  tool  setting,  gauge  making,  and  other  skilled  work  to 
qualified  disabled  men  recommended  by  local  committees. 

In  some  cases  men  are  placed  on  private  farms  for  training,  or 
entered  in  a  course  at  an  agricultural  college. 

MINISTRY-OF-PENSTONS    ACT. 

The  general  administration  of  this  work  has  been  modified  by  two 
acts  passed  since  the  war  pensions  act  of  1915,  namely,  the  ministry- 
of-pensions  act  of  1916,  and  the  naval  and  military  war-pensions 
act  of  1917. 

The  act  of  1916,  establishing  the  ministry  of  pensions,  brought 
the  statutory  committee  and  the  local  committees  under  control 
of  the  new  minister  of  pensions,  and  provided  that  thereafter  all 
tke  powers  and  duties  of  these  committees  should  be  exercised  in 
accordance  with  the  instructions  of  this  official. 

1  The  National  Leather  Goods  Manufacturers'  Association  offered  to  train  partly  disabled  men  in  light 
leather  v/ork.  Messrs.  Worral  &  Co.,  of  Birmingham,  sent  members  of  their  stall'  to  teach  leather  work 
to  Englishmen  in  Switzerland. 

Messrs.  Abdulla  &  Co.  (Ltd.)  sent  an  instructor  to  the  Shepherds  Bush  Orthopedic  Hospital  to  teach 
the  patients  the  art  of  rolling  cigarettes. 

An  English  firm  is  training  disabled  men  to  make  parts  of  fire  extinguishers. 

A  Scottish  firm  o)  manufacturers  stated  that  they  had  openings  in  a  beetling  mill  for  men  suffering  of 
deauiess. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     37 
XAVAL    AND    MILITARY    WAR-PENSIONS    ACT    OF    1917. 


On  April  19,  l£)17,  the  secretary  of  the  statutory  committee  wrote 
letters  to  the  prime  minister  and  to  the  minister  of  pensions,  inform- 
ing these  officials  that  the  statutory  committee  had  come  to  the 
conclusion  that  in  the  public  interest,  and  also  in  that  of  those  for 
whose  benefit  the  statutory  committee  was  constituted,  it  was 
desirable  that  the  committee's  functions  should  be  transferred  to 
the  minister  of  pensions.  It  was  explained  that  after  considering 
its  present  position,  and  since  the  ministry  of  pensions  had  been 
established,  a  resolution  to  the  following  effect  was  passed  on  the 
19th  of  April: 

That  in  the  opinion  of  the  statutory  committee  the  time  has  arrived  when  their 
functions  under  the  naval  and  military  war  pensions,  etc.,  act,  1915,  should,  subject 
to  the  necessary  modifications,  be  transferred  to  the  minister  of  pensions. 

The  committee  has  done  its  best  to  carry  out  its  f  auctions  under 
schemes  instituted  by  it.  Three  hundred  local  committees  have 
been  established  and  they  have  done  much  work  with  regard  to 
arrangements  for  the  treatment,  training,  and  employment  of  dis- 
abled men. 

The  formation  of  the  ministry  of  pensions,  placing  the  powers 
and  duties  of  the  committee  under  the  minister  of  pensions,  has 
altered  its  position.  There  is  a  cordial  feeling  between  the  committee 
and  the  ministry.  It  is  thought  to  be  impracticable,  however,  for 
the  committee  and  the  minister  to  deal  with  the  same  matters. 
It  is  considered  that  there  should  be  undivided  responsibility  and 
that  there  should  be  only  one  central  authority  to  which  local  com- 
mittees should  look  for  guidance  and  control.  Legislation  to  that 
effect  is  urged.  The  experience  gained  by  the  members  of  the 
committee  was  freely  placed  at  the  disposal  of  the  minister  of  pensions. 

Commenting  on  this  letter  and  its  recommendations  Cyril  Jackson, 
in  the  War  Pensions  Gazette  of  Jane,  1917,  made  the  following 
statements: 

The  statutory  committee  was  a  composite  body  including  members 
of  both  Houses  of  Parliament,  representatives  of  Government  depart- 
ments and  of  labor,  women,  and  other  persons  closely  associated 
with  the  voluntary  agencies  who  had  previously  assisted  the  soldiers 
and  sailors  and  their  families.  The  special  disablements  subcom- 
mittee did  much  to  prepare  the  ground  and  to  solve  the  difficult  prob- 
lem of  affording  assistance  to  disabled  men.  They  established 
advisory  trade  boards  and  wage  boards.  They  organized  the  local 
committees  upon  whom  the  whole  success  of  the  act  depended. 
On  'these  committees  a  definite  proportion  were  representatives  of 
labor;  of  the  old  voluntary  associations  and  women,  usually  one- 
fifth  for  each  class.  It  was  their  duty  to  prepare  the  schemes  and 
to  appoint  the  actual  personnel. 

The  local  committees  have  proved  themselves  effective.  The 
general  lines  of  training  and  treatment  of  the  disabled  men  are 
such  that  they  will  form  a  solid  foundation  for  any  work  in  the 
future. 

In  accordance  with  these  recommendations,  the  naval  and  mili- 
tary war-pensions  act,  passed  August  21,  1917,  dissolved  the  statu- 
tory committee  and  transferred  its  powers  and  functions  with 
regard  to  the  training  of  soldiers  and  sailors  to  the  minister  of  pen- 


38     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

sions,  who  was  instructed  to  constitute  a  committee  of  not  more 
than  12  members,  to  be  known  as  the  special  grants  committee,  with 
the  duty  of  assisting  him  in  performing  the  duties  imposed  upon 
him  by  the  act.  It  was  provided  in  the  act,  however,  that  nothing 
therein  should  affect  any  scheme,  regulation,  order  or  grant  made 
by  the  statutory  committee,  but  that  all  such  schemes,  regulations, 
and  orders  should,  until  altered  or  revoked  by  the  minister  of  pen- 
sions or  by  the  special  grants  committee,  with  the  approval  of  the 
minister  of  pensions,  continue  in  force,  the  ministry  or  the  special 
grants  committee  being  substituted  in  each  instance  for  the  statu- 
tory committee. 

REGULATIONS    FOR    TRAINING    DISABLED    MEN. 

The  minister  of  pensions  has  issued  a  pamphlet  entitled  "Instruc- 
tions and  Notes  on  the  Treatment  and  Training  of  Disabled  Men, 
1917."  This  pamphlet  deals  with  the  medical  treatment  as  well 
as  with  the  training  of  men.  Some  provisions  relating  to  training 
are  given  below: 

SEC.  19.  Training  shall  include  any  form  of  training  (other  than  orthopedic  manual 
training  '  *  *)  the  conditions  of  which  may  be  approved  by  the  minister  of  pen- 
sions. 

SEC.  20.  The  following  forms  of  training  are  approved: 

(1)  Training  in  any  agricultural  college,  farm  colony,  or  other  institution  estab- 
lished by  the  Board  of  Agriculture  and  Fisheries. 

(2)  Training  for  individual  men  (not  exceeding  five  at  anytime  in  any  single  indus- 
try) in  any  workshop  or  factory  subject  to  the  general  conditions  laid  down  in  sched- 
ule 4  (see below),  or  such  conditions  as  may  hereafter  be  approved. 

(3)  Training  given  in  accordance  with  any  scheme  approved  by  the  war  pensions 
statutory  committee  before  the  issue  of  these  instructions. 

SEC.  23.  Training  shall  not  conflict  with  interest  of  employers  and  employed  in 
any  trade.  The  minister  of  pensions,  after  consultation  with  minister  of  labor,  may 
issue  instructions  as  to  conditions  to  be  observed. 

SEC.  25.  The  local  committee  shall  decide  as  to  the  training  to  be  offered  to  and 
provided  for  disabled  men,  and  in  so  deciding  the  local  committee  shall  consider  in 
addition  to  the  man's  own  choice  of  occupation — 

(a)  His  previous  occupation. 

(6)  The  suitability  of  the  occupation  to  the  man's  age,  disability,  and  physical 
condition. 

(c)  The  recommendation,  if  any,  as  to  training,  which  may  be  indicated  on  the 
notification  of  award  of  pension  or  in  any  report  of  a  hospital  visitor. 

(d)  The  opportunities  for^ reaching  a  permanent  livelihood  in  the  occupation. 
SEC.  28.  The  local  committee,  if  satisfied  that  man  is  not  taking  full  advantage  of 

training,  may  stop  training  and  payment  of  allowance. 

Schedule  3  of  the  pamphlet  specified  conditions  under  which  train- 
ing may  be  given  in  technical  or  other  institutions.  Such  training, 
at  the  expense  of  the  minister  of  pensions,  must  be  approved  by  local 
education  authority;  only  ordinary  fees  may  be  paid  for  regular 
courses ;  and  for  special  courses  instituted  for  disabled  men  fees  rep- 
resenting only  additional  expenses  necessitated  by  the  institution, 
not  exceeding  7s.  6d.  per  head  per  week,  may  be  paid.  It  is  further 
specified  that  the  joint  committee  and  trade  associations  must  be 
consulted ;  that  reasonable  certainty  of  employment  must  be  assured ; 
that  the  period  of  training  shall  not  exceed  six  months,  unless 
conditions  of  trade,  etc.,  satisfy  the  minister  of  pensions  that  a  longer 
period  is  necessary.  Finally  it  is  provided  that  maimed  men  shall 
not  be  required  to  live  away  from  home,  except  with  the  sanction 
of  the  minister  of  pensions,  and  that  in  such  cases  there  must  be 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     39 

mable  certainty  that  a  position  will  be  secured  at  the  home 
town,  or  that  the  man  will  be  willing  to  move  to  a  place  where  a 
position  may  be  secured. 

Schedule  4  relates  to  training  in  workshops  or  factories  of  private 
employers  or  public  companies.  It  is  specified  that  employers  must 
give  definite  instruction  to  the  men,  and  make  reports  on  progress; 
that  adequate  training  must  be  given,  together  with  promise  of 
permanent  employment  and  fair  wages;  that  the  employers  must 
teach  the  man  enough  to  insure  his  employment;  that  no  fees  shall 
be  paid  without  the  sanction  of  the  minister  of  pensions;  that  the 
local  committee  shall  have  the  right  of  withdrawal;  that  the  employer 
shall  pay  wages  equal  to  the  net  value  of  the  work  done  by  the  man  in 
training,  and  that  the  allowance  to  the  man  from  the  committee  shall 
be  reduced  by  this  amount;  that  the  scheme  shall  be  approved  by  the 
local  trade  association ;  and  that  the  period  of  training  shall  not  exceed 
four  months  unless  conditions  satisfy  the  minister  of  pensions  that  a 
longer  period  is  necessary. 

The  pamphlet  states  that  each  local  committee  must  feel  respon- 
sible for  all  men  in  its  district — not  alone  for  those  who  present 
themselves  to  the  committee.  The  local  committee  is  furnished  with 
information  by  the  military  hospital  from  which  the  man  is  discharged, 
the  minister  of  pensions  granting  pension  or  gratuity,  the  military 
hospital  white  card  indicating  treatment  when  necessary,  and  the 
hospital  visitor  reporting  on  the  man's  suitability  for  training. 

EMPLOYMENT. 

Employment  of  men  released  from  military  service  is  under  the 
direction  of  the  special  grants  committee  of  the  ministry  of  pensions 
working  in  close  collaboration  with  the  employment  department  of 
the  ministry  of  labor. 

England  anticipated  difficulty  with  the  labor  unions.  The  unions 
have  fought  for  50  years  for  the  minimum  wage  and  other  rights. 
After  the  first  patriotic  impulse  had  worn  away,  and  the  liquidation  of 
labor  began,  labor  unrest  became  apparent,  in  consequence  of  changed 
conditions,  involving  long  hours,  increased  wages,  and  profit  making  by 
employers.  It  became  necessary  to  pass  the  first  munitions  act,  and 
it  has  since  been  necessary  for  the  Government  to  regulate  wages. 
The  unions  have  given  up  many  of  their  rights  on  the  condition  that 
they  be  returned  at  the  close  of  the  war.  The  employing  of  the 
disabled  soldier  adds  to  the  complications  and  caUs  for  careful  wage 
adjustment. 

TRADE    ADVISORY    COMMITTEES. 

In  order  intelligently  to  achieve  the  return  of  disabled  soldiers  and 
sailors  to  civil  employment  and  with  the  least  possible  friction 
between  capital  and  labor,  trade  advisory  committees  have  been 
formed  in  the  different  trades  for  regulating  the  training  and  employ- 
ing of  such  men. 

The  trade  advisory  committee  is  expected  to  give  advice  with 
reference  to  character  and  duration  of  training,  and  the  number  of 
men  to  be  trained  in  the  particular  trade.1 

i  Trade  advisory  committees  have  been  formed  for  the  following  trades:  Cane  willow,  building,  furniture, 
engineering  and  shipbuilding,  tailoring,  boot  and  shoe  repairing,  boot  and  shoe  manufacture,  gold,  silver, 
and  jewelry,  brush  making,  printing  and  kindred  trades,  paper,  paper  goods,  cinematograph,  electricity 
and  substations,  and  mechanical  dentistry.  Such  committees  have  been  proposed  lor  the  electrical 
industry,  the  textile  trades,  and  coal  mining. 


40     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

The  membership  of  each  trade  advisory  committee  is  composed  as 
follows: 

(1)  A  chairman,  appointed  by  the  ministry  of  labor  if  not  agreed 
upon  by  the  committee. 

(2)  An   equal   number   of   representatives    of   employers    and    of 
workmen. 

A  representative  of  the  special  grants  committee,  and  a  repre- 
sentative of  the  employment  department  of  the  ministry  of  labor 
attend  as  consultants. 

The  duties  of  these  committees  are: 

(1)  To  advise  on  all  questions  relative  to  reinstatement  of  disabled 
former  employees. 

(2)  To  study  the  possibility  of  permanent  employment  of  those 
not  previously  in  trade. 

(3)  To  report  on  plans  of  training  for  the  disabled  in  technical 
schools  or  factories,  and  as  to  suitable  centers  for  such  training. 

(4)  To  advise  with  regard  to  rate  of  wages  to  be  paid  to  disabled 
employed  in  the  trade. 

ADVISORY    WAGES    BOARDS. 

In  addition  to  the  trade  advisory  committees,  the  ministry  of 
labor  has  set  up  advisory  wages  boards  in  the  principal  trades.  The 
functions  of  these  two  sorts  of  committees  are  quite  different. 

The  trade  advisory  committees  deal  with  national  industries  and 
local  committees  are  expected  to  investigate  local  and  special 
industries. 

The  advisory  wages  boards  deal  with  rates  of  wages  for  disabled 
men,  and  furnish  authoritative  opinion  on  the  rate  of  wages  which 
each  disabled  man  should  have  in  relation  to  his  physical  handicap, 
the  impairment  of  his  efficiency,  the  current  local  rate  of  wages,  and 
any  other  factors  which  must  be  taken  into  account. 

Each  board  consists  of  a  permanent  chairman  appointed  by  the 
ministry  of  labor,  and  a  representative  of  employers  and  workmen, 
with  not  more  than  three  members  of  the  local  war  pensions  com- 
mittee who  are  assessors  without  the  right  to  vote.  The  clerk  of 
the  board  is  an  officer  of  the  ministry  of  labor.  Representatives  hold 
office  for  a  period  of  not  less  than  12  months,  and  the  length  of  service 
is  determined  by  the  ministry  of  labor. 

Advice  with  reference  to  a  man's  earning  capacity  is  given  to  any 
employer  or  workman  or  to  the  local  war  pensions  committee  or  to 
the  secretary  of  the  local  war  pensions  committee  with  reference  to 
the  wage  of  any  workman  engaged  upon  a  specific  work.  In  giving 
advice  pensions  are  not  to  be  considered. 

The  chairman  of  the  board  is  usually  the  chairman  of  the  local 
court  of  references.  (Pt.  11  of  the  national  insurance  act,  1911.) 

The  board  can  not  enforce  its  decisions.  Its  opinion,  however, 
is  expected  to  be  final. 

INQUIRY    INTO    TRADES. 

England  has  started  a  systematic  inquiry  into  trades  which  will 
be  suitable  for  the  disabled.  Inquiry  blanks  and  schedules  to  secure 


YOCAT10XAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     41 

all  information   desired   relative   to   occupations,    processes,   wages, 
conditions,  etc.,  are  to  be  filled  by— 

1.  Inspectors  of  technical  schools  of  the  board  of  education. 

•J.  Home  office  factory  inspectors. 

Officials  of  the  employment  department. 

4.  Selected  manufacturers  or  persons  having  a  detailed  knowledge 
of  the  trade. 

In  order  to  procure  data  showing  the  exact  nature  of  each  process 
in  relation  to  the  disabled,  a  schedule  is  filled  for  each  separate 
process,  not  for  a  trade  as  a  whole.  Processes  are  not  investigated 
which  are  known  to  be  too  hard  or  too  unhealthy;  or  which  can  be 
learned  only  by  beginning  as  a  boy;  or  which  are  performed  by 
women  under  normal  labor  conditions,  or  by  young  people;  or  in 
crises  where  the  trade  is  known  to  be  declining,  or  seasonal,  or  to 
yield  under  normal  conditions  a  low  wage. 

The  purpose  of  the  inquiry  is  to  find  permanent  employment 
for  the  disabled  and  to  avoid  the  danger  of  men  taking  temporary 
positions  under  present  abnormal  labor  conditions. 

The  corps  of  commissionaires  (headquarters  London,  branches  in 
large  cities)  is  the  largest  organization  dealing  with  discharged  ex- 
service  men  not  wishing  to  take  up  a  skilled  trade.  All  men  dis- 
charged for  wounds  who  have  served  in  regular  forces  or  auxiliary 
forces  who  qualify  in  health,  physique,  and  education  are  eligible. 
Commissionaires  are  engaged  by  employers  as  watchmen,  clerks, 
time  and  gate  keepers,  messengers,  gymnastic  and  drill  instructors, 
grooms,  boatmen,  and  porters. 

The  employment  bureaus  in  connection  with  hospitals  place  men 
as  chauffeurs,  garage  attendants,  assistant  electricians,  elevator 
operators,  repair  carpenters  on  estates,  and  in  other  employments. 
Engineering  and  chemical  industries  need  men  of  technical  training 
and  there  is  opportunity  of  employment  for  the  men  in  stores, 
hotels,  and  shops. 

The  local  committees  are  furthering  employment  of  the  men  in 
every  possible  way.1 

Upon  discharge  the  address  of  the  man  is  sent  to  the  employment 
exchange  in  the  district  to  which  he  is  to  go. 

The  further  duties  of  the  local  committee  are  briefly  indicated  in 
the  following  paragraph,  quoted  from  Capt.  Williams's  article,  cited 
above: 

After  the  disabled  man's  training  is  completed  the  local  committee  is  responsible 
f«T  eyeing  that  he  obtains  the  employment  for  which  he  is  fitted.  In  many  cases 
employment  follows  naturally  upon  training;  employers  who  take  disabled  men  as 
apprentices,  farmers  who  train  them  for  agriculture,  the  ministry  of  munitions  which 
gives  them  technical  instruction,  will  generally  be  able  to  find  them  work  when  the 
training  is  completed.  In  many  cases  a  man  has  had  his  job  reserved  for  him  by  his 
foinu'r  employer,  or  he  may  find  no  difficulty  in  placing  himself,  owing  to  his  former 
connections.  But  there  are  many  other  cases  where  a  search  for  employment  has  to 
be  made.  Then  the  committee  will  consult  the  trade  panel  already  mentioned  or 
pee  that  the  labor-exchange  officials  do  their  best  to  find  suitable  work.  Happily 
there  is  a  natural  disposition  among  employers  to  help  the  disabled  as  much  as  they 
can;  among  all  the  demands  for  men  made  on  the  labor  exchanges  by  employers 
between  May,  1915,  and  December,  19] 6,  it  was  stipulated  in  no  less  than  24,635 
;  hat  discharged  soldiers  and  sailors  should  be  given  the  preference.  From  other 
returns  ror  the  same  period  it  is  clear  that  hardly  any  discharged  soldiers  who  had 
applied  through  labor  exchanges  had  no  work  found  for  them. 

1  From  May,  1915,  t->  July  13, 1917,  there  were  127,300  registrations  and  59,400  disabled  men  placed.    At 
that  time  there  were  about  2,800  men  waiting  for  employment. 


42     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILOE^ 

FRANCE. 
EARLY  EFFORTS  FOR  REEDUCATION. 

In  France — as  in  Belgium  and  Italy,  but  in  contrast  to  the  system 
in  England — training  of  disabled  men  is  as  far  as  possible  compulsory, 
and  in  France  and  Italy  such  training  ceases  when  the  man  is  dis- 
charged from  the  army^  or  navy.  In  some  cases,  however,  difficulty 
has  been  experienced  in  forcing  men  to  take  up  courses  in  profes- 
sional reeducation,  except  such  -as  are  prescribed  in  the  hospital 
workshop. 

It  is  stated  that  methods  in  France  "have  not  yet  reached  a  final 
form,"  a  statement  which  is  undoubtedly  true  also  of  the  methods 
which  have  been  developed  in  other  belligerent  countries.  Neverthe- 
less, in  France  considerable  progress  has  been  made  in  the  develop- 
ment of  a  central  agency  of  coordination  in  the  work  of  reeducation 
and  placement  of  disabled  men. 

Very  early  in  the  war  public  and  private  agencies  undertook  to 
provide  training  for  disabled  men,  the  efforts  made  to  give  such 
training  being  necessarily,  under  the  conditions,  in  the  nature  of 
spontaneous  uncoordinated  reactions  to  a  tremendous  and  unprovided- 
for  emergency.  Within  the  first  few  weeks  of  the  war  thousands  of 
men  were  wounded  and  crippled  in  the  fierce  campaign  to  stop  the 
onrush  of  invaders.  These  men,  unfit  for  further  military  service, 
and  in  many  cases  unfit  without  special  training  to  take  up  any 
sort  of  civil  employment,  were  thrown  back  upon  the  community, 
which,  while  recognizing  its  obligation  to  provide  for  them,  found 
itself  quite  unprepared  for  the  task. 

France  was  thus  under  the  immediate  necessity  of  doing  the  work, 
without  planning  how  best  to  do  it,  and  it  may  be  observed  that 
while  France  has  been  developing  her  methods  of  administration, 
she  has  been  teaching  the  art  of  rehabilitation  of  disabled  men  to 
the  world,  especially,  it  should  perhaps  be  added,  the  art  of  func- 
tional and  orthopedic  rehabilitation,  rather  than  of  vocational 
reeducation. 

The  necessities  for  and  the  advantages  of  vocational  reeducation 
are,  however,  fully  recognized  in  France,  although  it  is  admitted 
that  many  men  who  might  with  advantage  to  themselves  have 
undertaken  a  course  of  vocational  reeducation  have  failed  or  refused 
to  undertake  such  a  course.  In  a  word,  the  system  of  compulsory 
training  seems  to  have  been  only  partially  successful. 

Private  agencies  and  societies,  municipalities,  provincial  govern- 
ments, and  the  various  departments  of  the  Central  Government 
reacted  directly  and  more  or  less  independently  to  the  conditions 
which  had  suddenly  developed.  Definition  01  function  and  co- 
ordination of  activities  among  these  diverse  agencies  is  not  yet 
complete. 

The  first  school  for  training  wounded  and  crippled  men  was  estab- 
lished by  the  municipality  of  Lyon  in  December,  1914.  This  school 
provided  accommodations  for  the  training  of  200  men  in  various 
employments.  The  minister  of  war  paid  the  school  a  subsidy  of 
3.50  francs  a  day  per  pupil.  Other  municipalities  established 
similar  schools. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     43 

Under  the  department  of  comme.v^  courses  were  organized  in 
technical  schools  and,  under  the  department  of  agriculture,  in 
agricultural  schools.  The  department  of  interior  established  large 
training  schools  especially  for  reeducation  of  soldiers  a-nd  sailors. 
Disabled  men  were  trained  not  only  for  employment,  but  as  teachers 
to  train  other  disabled  men,  on  the  principle  that  no  one  better  than 
a  mutile  can  train  a  inutile.1 

Utilization  of  all  available  resources,  public  and  private,  character- 
izes all  the  work  of  caring  for  disabled  men  in  France  from  the  time 
they  enter  the  hospitals  until  they  are  reestablished  in  some  wage- 
earning  employment.  All  hospitals  for  active  medical  and  surgical 
treatment  are  under  the  general  control  of  the  service  de  santS  of 
the  war  department.  Some  of  these  hospitals  have  been  established 
and  are  supported  by  private  individuals  or  societies,  such  as  the 
French  Red  Cross;  some  have  been  established  by  civilian  and  some 
by  military  authority.  Patients  in  hospitals  are  given  such  work  as 
they  can  do,  as  a  means  of  hastening  their  convalescence,  and  in 
many  hospitals  materials,  instruments,  and  instruction  are  provided 
by  private  societies.  One  society  undertakes  to  find  a  market  for 
any  product  turned  out.  Bags  and  flares  and  other  products  are 
made  for  the  army  by  hospital  patients.  At  this  light  work  in  the 
hospital  workshops  the  men,  it  is  said,  may  earn  from  2  to  4  francs 
a  day.2 

"  OFFICE    NATIONAL   DES    MUTILES    ET    REFORMES    DE    LA    GUERRE." 

For  the  return  of  men  to  civil  employment  after  their  active 
medical  treatment  is  completed  the  central  agency  of  coordination  in 
France  is  now  the  "  office  national  des  mutiles  et  reformes  de  la 
guerre." 

This  national  office  was  instituted  under  a  joint  decree  of  the 
minister  of  w^ar,  the  minister  of  the  interior,  and  the  minister  of 
labor,  under  date  of  March  2,  1916,  for  the  purpose  of  coordinating 
the  efforts  of  public  and  private  agencies  which  were  seeking  to 
facilitate  the  return  of  men  disabled  in  the  war  to  active  civil  life 
under  conditions  most  advantageous  for  them  and  for  the  com- 
munity. 

As  lias  been  noted,  before  the  creation  of  the  national  office 
numerous  agencies,  public  and  private,  had  been  established  for  the 
training  and  return  to  wage-earning  employment  of  disabled  men. 
The  minister  of  commerce  and  the  minister  of  agriculture  had  e 

i  Classification  of  the  centers  of  vocational  education: 

1.  National  Institute,  St.  Maurice. 

2.  Centers  created  by  public  administration  connected  with  centers  of  functional  reeducation.    In 
order  to  obtain  State  subsidy  these  institutions  must  submit  their  proposed  budget  and  program  t  j  the 
national  oilice  showing  number  of  trades  taught,  probable  number  of  pupils,  statement  of  program  of 
instruction,  schedule  of  weekly  hours  of  instruction,  equipment,  duration  of  training,   }v 

after  training,  and  degree  of  physical  ability  necessary  for  the  exercise  of  trades  taught.    Vocal  ion.il  schools 
under  jurisdiction  of  the  ministers  of  agriculture  or  commerce  which  organize  special  courses  ' 
reeducation  of  the  disabled  corne  under  this  group. 

3.  Public  institution  other  than  occupational  schools  and  not  attached  to  a  center  of  functional  i, 
tation  and  private  institution.    These  are  free  as  to  organization,  but  must  submit  program  and 

if  desiring  subsidy.    The  State  subsidy  is  in  proportion  to  the  number  of  pupils.    The  granting  of  a 

subsidy  does  not  constitute  an  obligation  for  partial  or  for  entire  renewal.     Continuation  of  the  . 

is  conditional  upon  State  supervision.    During  1916  the  reeducation  commission  of  i  tl  o.'lk'e 

advised  generally  upon  the  repartition  of  the  subventions  to  schools.    These  expenditures  w 

a  credit  on  the  budget  of  the  minister  of  the  interior. 

1  The  statements  regarding  French  hospitals  are  summarized  from  an  article  by  Maj.  John  L.  Todd.  in 
tne  American  Journal  of  Care  for  Cripples,  September,  1917. 


44     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIEKS  AND  SAILOES. 

lislied  sections  reserved  for  the  training  of  invalided  men  in  the 
technical  and  agricultural  schools  under  the  general  direction  of 
these  ministries.  ^  The  minister  of  the  interior  had  grouped  in  centers 
of  reeducation,  in  different  regions  of  France,  schools  organized 
especially  for  the  reeducation  of  disabled  soldiers.  The  minister  of 
war  had  organized  a  placement  service  for  invalided  men,  and  pro- 
posed to  organize  sections  for  vocational  reeducation  in  connection 
with  the  hospital  centers  of  physio-therapeutic  treatment. 

The  minister  of  labor,  in  a  circular  issued  February  10,  1916,  had 
discussed  the  advisability  of  creating  special  institutions  for  the  em- 
ployment of  crippled  soldiers.  After  setting  forth  reasons  showing  the 
inadvisability  of  creating  such  institutions,  the  circular  directed  that 
all  public-employment  officers  should  collect  all  requests  for  employ- 
ment made  to  them  by  soldiers  and  should  also  solicit  such  requests, 
and  that  in  cases  where  possible  applicants  should  be  placed  in  their 
former  occupations  and  in  their  former  localities.  It  further  directed 
that  if  they  found  soldiers  whose  industrial  ability  or  physical  condi- 
tion could  be  improved,  the  papers  of  these  soldiers  should  be  sent  to 
the  central  office,  which,  in  cooperation  with  the  bureaus  of  the 
minister  of  war,  would  send  them  to  institutions  for  rehabilitation. 

The  utility  of  a  central  office  w^hich  should  undertake  to  coordinate 
these  divergent  and  disparate  developments  and  to  secure  economy 
of  effort  and  resource  without  lessening  private  initiative  and  enter- 
prise was  apparent.  Accordingly  the  national  office  was  created  and 
its  composition  and  functions  were  generally  defined  by  three  joint 
ministerial  decrees  dated,  respectively,  March  2,  March  16,  and 
May  11,  1917.  Under  the  terms  of  these  orders  the  national  office 
was  extended  to  include: 

First.  The  office  of  centralization  and  investigations  heretofore 
existing  under  the  minister  of  war. 

Second.  Tha  commission  to  regulate  the  organization  of  profes- 
sional centers  for  the  reeducation  of  wounded  and  disabled  soldiers 
heretofore  existing  under  the  minister  of  the  interior. 

Third.  The  central  office  of  employment  and  the  public  offices  of 
employment  connected  with  the  central  office  heretofore  existing 
under  the  ministry  of  labor. 

It  was  also  decreed  that  the  office  was  to  be  administered  by  a 
commission  composed  of  two  representatives  of  the  ministers  of  labor, 
war,  and  interior,  respectively.  The  minister  of  labor  was  later 
designated  as  president  of  the  commission.  There  was  also  added  a 
council  of  employment,  in  which  there  were  to  be  representatives  of 
private  organizations  working  for  the  disabled. 

The  office1  comprises: 

1 .  A  committee  of  administration  composed  of  nine  members  desig- 
nated by  the  ministers  of  labor,  war,  and  interior,  which  is  charged 
with  the  duty  of  collecting  information,  and  of  maintaining  a  con- 
stant interrelationship  between   the  various  public  services  which 
are  occupied  with  the  care  of  disabled  men. 

2.  A  reeducation  commission  originally  established  by  the  minister 
of  interior,  which  advises  in  technical  matters  of  reeducation,  and  in 
the  matter  of  requests  for  subventions  to  centers  of  reeducation. 

1  The  following  account  of  the  French  national  office  is  summarized  from  a  report  (Bulletin  No.  1.  Annee 
1196)  issusd  by  the  office  covering  its  work  during  1916.  In  this  bulletin  the  statement  is  made  that  •  'the 
national  office  is  to  be  appealed  to  for  its  advice  on  all  general  measures  relating  to  maimed  soldiers,  especially 
on  the  centralisation  of  information  relating  to  vocational  education. " 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     45 

3.  A  welfare  council  (council  de  perfectionment)  composed  of  persons 
specially  qualified  by  experience,  and  of  representatives  of  private 
societies,  which  is  charged  with  caring  for  the  general  welfare  of 
disabled  men. 

PROVINCIAL    COMMITTEES. 

In  a  majority  of  the  French  Provinces  provincial  committees  for 
the  care  or  disabled  men  have  been  organized  to  aid  the  national 
office.  In  the  Provinces  severally  the  functions  of  these  committees 
are  similar  to  those  of  the  national  office  in  the  country  as  a  whole — • 
namely,  to  coordinate  the  work  being  done  in  each  Province,  to  in- 
sure cooperation  between  existing  agencies,  and  to  encourage  the 
establishment  of  new  agencies  as  needed.  These  committees  vary  in. 
composition  from  Province  to  Province,  the  object  being  in  each 
Province  to  associate  together  those  persons  who  can  most  surely 
give  efficient  aid.  In  general,  the  local  committee  comprises  civil 
and  military  representatives  such  as,  for  the  minister  of  labor,  the 
inspector  of  labor,  and  the  chief  of  the  provincial  oflice  of  placement; 
for  the  minister  of  war,  a  delegate  representing  the  general  in  com- 
mand of  the  subdivision,  the  local  pension  officer,  and  a  member  of 
the  army  health  service;  and  in  addition,  representatives  of  agricul- 
tural services,  of  technical  and  public  instruction,  of  medical  socie- 
ties, of  employers'  associations,  of  labor  organizations,  and  of  other 
associations. 

REHABILITATION. 

The  stages  in  the  rehabilitation  of  a  disabled  soldier  in  France 
may  be  described  as  follows: 

fle  is  sent  to  a  center  of  readaptation  which  consists  of  a  physio 
therapeutic  center,  a  center  of  prosthesis  and  a  center  of  vocational 
training.  The  institution  is  given  directions  concerning  the  patient. 
He  selects  his  own  occupation  with  the  advice  of  the  physician  in 
charge  and  the  representative  of  a  departmental  committee  who  is 
the  vocational  officer.  Before  the  patient's  education  is  complete 
the  proper  employment  agency  is  communicated  with.  In  deter- 
mining the  pension  rate  no  deduction  is  made  for  reeducation,  skill, 
or  earning  power.  After  the  man  is  placed  the  national  office  con- 
tinues to  feel  a  certain  responsibility  tor  him.  A  patient  previously 
discharged  may  reapply  for  vocational  education. 

There  are  several  classes  of  institutions  for  reeducation,  among 
which  the  following  may  be  noted: 

1.  Schools  with  technical  shops  reserved  for  the  disabled. 

2.  Combined  lodging  and  boarding  houses  in  which  the  disabled 
can  be  reeducated  in  special  shops  or  attend  regular  classes  in  trade 
schools. 

3.  Shops  of  trade  associations  organized  for  use  of  the  disabled 
according  to  occupational  groups. 

4.  Individual  grants  permitting  reeducation  near  residence. 

The  aim  is  to  shorten  the  period  of  reeducation  as  much  as  possible, 
at  the  same  time  providing  adequate  courses.  Account  is  taken  of 
the  desire  of  the  men  to  return  to  their  homes  as  soon  as  possible 
and  to  regain  their  personal  liberty. 


46     VOCATIONAL  REHABILITATION.  OF  DISABLED  SOLDIEES  AND  SAILORS. 

REGISTER. 

The  national  office  maintains  a  complete  register  of  invalided  men, 
showing  for  each  man  his  civil  and  military  status,  the  nature  of  his 
disability,  his  occupation  before  the  war,  and  his  new  employment. 
For  collecting  these  data,  the  comite  <T administration  of  the  national 
office  has  prepared  schedules  of  inquiries  to  be  filled  out  and  returned 
to  the  office  by  the  proper  authorities.  By  December  31,  1916, 
20,000  schedules  had  been  filled  out  and  returned  to  the  office  through 
the  agency  of  the  public-health  service.  Additional  names  had  been 
secured  from  the  provincial  prefects  and  from  the  fists  of  pensioners. 

INQUIRY    INTO    TRADES. 

The  office  has  also  instituted  inquiries  among  employers  regarding 
the  employment  of  men  injured  in  industry,  with  a  view  to  deter- 
mining what  employments  are  suitable  for  men  with  given  handicaps. 
Circulars  have  been  addressed  to  employers  explaining  how  they  can 
assist  in  providing  employment  for  disabled  men — as,  for  example, 
by  reserving  places  in  their  workshops  insuring  the  disabled  man  the 
same  position  which  he  held  before  the  war;  by  installing  special 
machines  and  equipment  adapted  to  the  needs  of  handicapped  men; 
and  by  establishing  special  workshops  for  teaching  (de  reapprentis- 
sage)  old  and  new  trades  to  such  men.  These  circulars  brought  into 
the  national  office  a  large  number  of  offers  of  employment. 

RESERVATION    OF   EMPLOYMENTS. 

To  facilitate  the  placement  of  invalided  men,  certain  employments 
were  reserved  for  such  men  by  an  act  passed  April  17,  1916.  This 
act  provides  that  men  disabled  in  the  present  war  shall,  during  the 
war  and  for  a  period  of  five  years  after  the  termination  of  the  war,  be 
given  preference  in  obtaining  appointments  in  certain  public  service 
employments,  according  to  administrative  regulations  and  schedules. 
The  act  is  based  upon  an  act  of  March  21,  1905,  making  similar  reser- 
vations for  invalided  men.  Under  this  act  three  schedules  of  em- 
ployments, E,  F,  and  G,  in  the  public  service  were  reserved;  E  being 
employments  for  under  officers  who  had  been  in  the  service  at  least 
ten  years;  F,  employments  for  underofficers,  brigadiers ,  and  corporals, 
after  four  years  of  service ;  and  G,  employments  for  soldiers  after  four 
years  of  service.  According  to  the  law  of  April  17,  1916,  preference 
is  to  be  exercised  so  as  to  favor  fathers  of  large  families. 

The  act  provides  that  an  administrative  decree,  to  be  issued  within 
three  months  of  the  passage  of  the  act,  shall  determine  the  necessary 
measures  for  the  application  of  the  law,  enumerate  the  categories  of 
wounds  or  infirmities  permitting  competition  for  securing  any 
reserved  employment,  and  indicate  the  manner  of  securing  certifi- 
cates of  professional  aptitude,  and  the  conditions  under  which  names 
of  candidates  shall  be  inscribed  on  special  lists,  one  such  list  being 
established  for  each  employment. 

Under  the  act,  public  services,  as  well  as  industrial  and  commercial 
enterprises  enjoying  a  concession,  a  moiioply,  or  a  subvention  from 
the  State,  from  a  provincial  government,  or  from  a  commune,  are 
required  to  prepare  lists  of,  and  to  indicate  the  conditions  of  access 


I 

VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILOES.     47 

to  employment  not  reserved  which  are  of  such  a  nature  as  will  permit 
of  their  being  assigned  to  soldiers  under  preferential  rights.  These 
lists  are  promulgated  by  a  decree  signed  by  the  minister  of  war  and 
each  interested  ministry. 

It  is  provided  further  that  no  commercial  or  industrial  enterprise 

shall  in  the  future  obtain  from  the  State,  Province,  or  commune,  a 

on,  monopoly,  or  subvention,  except  on  condition  of  reserving 

by  contract  a  certain  number  of  employments  for  invalided  soldiers. 

vSoldiers  who  before  their  mobilization  held  one  of  the  reserved 
employments,  are,  if  their  condition  permits,  reinstated  in  their  old 
employment,  or  in  another  employment  in  the  same  service,  reserved 
or  not  reserved. 

The  administrative  decree  provided  for  in  this  act  was  issued  July 
18,  1916.  It  provides  for  detailed  reports  for  each  man,  including  a 
report  by  two  military  doctors,  for  listing  men  according  to  qualifica- 
tions for  employment  as  well  as  for  the  regular  notification  of  vacancies 
to  be  filled  in  the  various  offices. 

EMPLOYEE'S  LIABILITY  IN  CASE  OF  INJURY. 

A  law  enacted  November  25,  1916,  provides  that  in  case  of  injury 
suffered  by  an  invalided  soldier  or  sailor  in  the  course  of  an  employ- 
ment, the" judgment  fixing  the  amount  to  be  paid  under  the  French 
insurance  laws  shall  determine  specifically  (1)  whether  the  cause  of 
the  accident  was  exclusively  the  preexisting  injury  incurred  in  war 
service,  and  (2)  whether  the  permanent  reduction  in  capacity  re- 
sulting from  the  accident  was  increased  by  the  preexisting  war  infirm- 
itv,  and  in  what  proportion.  In  the  first  case  the  employer  is  relieved 
of  all  charges  on  account  of  the  accident,  and  in  the  second  case 
of  a  proportion  of  the  charges  equal  to  the  aggravation  as  determined 
in  the  judgment.  These  charges  lifted  from  the  individual  employer 
are  paid  out  of  a  special  fund  maintained  by  a  tax  levied  annually 
upon  employers  and  insurance  organizations. 

CANADA. 

MILITARY   HOSPITALS    COMMISSION. 

There  appears  to  be  no  statute  enacted  by  the  Canadian  Parliament 
dealing  with  vocational  education  of  disabled  veterans  of  the  war. 
There  are,  however,  several  orders  in  council  containing  provisions  in 
regard  to  this  subject. 

By  order  341,  approved  June  30,  1915,  the  hospital  commission  was 
appointed  for  the  purpose  of  providing  hospital  accommodations  and 
convalescent  homes  in  Canada  for  officers  and  men  of  the  Canadian 
expeditionary  force  who  returned  invalided  from  the  front.  By  the  order 
the  commission  was  empowered  to  incur  and  authorize  expenditures 
connected  with  the  treatment  and  care  of  the  sick  and  wounded  as 
well  as  with  the  organization  and  administration  of  hospitals  and 
homes.  Such  expenditures  are  to  be  charged  against  the  war  appro- 
priation vote  or  against  some  other  special  fund  set  aside  by  Parlia- 
ment. 

By  subsequent  order,  No.  420,  approved  October  14,  1915,  this 
commission  was  abolished  and  in  lieu  thereof  the  military  hospitals 


48     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

and  convalescent  homes  commission  was  established.  This  latter 
committee  was  authorized  to  select  medical  and  nursing  staffs  and  to 
recommend  to  the  governor  in  council  an  expenditure  which  it  con- 
sidered necessary  for  the  treatment  and  care  of  the  wounded;  to 
accept  such  funds,  bequests,  and  legacies  as  were  devised  to  it,  and  to 
make  all  expenditures  of  such  bequests,  etc.,  on  behalf  of  the  members 
of  the  Canadian  expeditionary  forces  for  the  purpose  of  carrying  out 
such  objects  as  were  decided  upon  by  the  commission.  It  was  em- 
powered to  deal  also  with  the  question  of  the  employment  of  members 
of  the  Canadian  expeditionary  force  on  return  to  Canada,  and  was 
authorized  to  cooperate  with  provincial  governments  for  the  purpose 
of  providing  such  employment.  Any  expenditure  incurred  by  the 
commission  under  authority  of  the  governor  in  council  is  made  a 
charge  against  the  war  appropriation  vote  or  any  other  available 
appropriation  made  by  Parliament  for  the  p'urpose. 

On  April  4,  1916,  this  order  was  amended  by  order  No.  692,  which 
added  Dr.  Shepherd,  dean  of  medicine  in  the  University  of  McGill, 
and  Mr.  Peters,  chairman  of  the  Returned  Soldiers'  Club,  to  the 
commission,  it  having  been  decided  to  establish  a  branch  for  thera- 
peutic and  functional  treatments  under  the  direct  supervision  of  a 
permanent  medical  authority. 

By  order  No.  880,  approved  June  29,  1916,  a  scale  was  established 
prescribing  the  sums  to  be  granted  for  personal  expenses  to  men 
undergoing  training,  provisions  being  made  on  a  sliding  scale,  for 
married  men  and  their  dependents  and  unmarried  men  having 
dependents. 

The  pay  provided  was  to  continue  for  one  month  after  completion 
of  vocational  training  whether  or  not  employment  had  been  secured. 
The  order  establishing  the  scale  refers  to  the  report  dated  June  17, 
1917,  made  by  Hon.  Sir  James  A.  Lougheed,  president  of  the  military 
hospitals  commission,  regarding  the  vocational  training  of  members 
of  the  Canadian  expeditionary  force.  It  also  states  that  the  duty  of 
the  State  to  provide  training  for  some  new  occupation  for  those  dis- 
abled in  war  has  been  recognized  by  all  the  nations  now  at  war;  that 
the  people  of  Canada  are  strongly  in  favor  of  suitable  provision  being 
made  for  vocational  training  for  disabled  soldiers;  that  technical 
schools,  agricultural  colleges,  and  other  public  institutions  have 
agreed  to  receive  disabled  men  for  training;  and  that  many  offers 
have  been  received  from  private  commercial  establishments  to 
provide  training  and  subsequent  employment  when  men  have  become 
proficient. 

The  military  hospitals  commission  upon  its  organization  created  as 
branches  central  provincial  committees.  The  Province  of  Ontario  by  an 
act  of  legislature  entitled  "  the  soldiers'  aid  commission  act,"  approved 
April  27,  1916,  confirmed  the  appointment  of  the  central  provincial 
committee  appointed  for  the  Province  of  Ontario,  and  declared  the 
committee  to  be  to  all  intents  and  purposes  legal  and  valid.  This  act 
also  provided  that  the  commission,  acting  as  the  central  provincial 
committee  for  the  Province  of  Ontario,  in  addition  to  the  members 
of  the  Canadian  expeditionary  force,  should  also  aid  any  member  of 
His  Majesty's  imperial  forces,  or  the  forces  of  any  of  the  allies  who 
as  reservists  and  while  resident  in  Canada  were  called  upon  to  serve 
in  the  imperial  forces  or  any  of  the  forces  of  the  allies,  and  who  as  a  result 
of  wounds,  disease,  or  other  injuries  sustained  during  the  period  of  enlist- 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.    49 

ment ,  wore  unable  to  pursue  their  former  calling  or  occupation.  By  the 
provisions  of  the  act  the  committee  was  authorized  to  enter  into 
arrangements  with  the  department  of  education  of  Ontario  or  with 
any  educational  authority  or  institution  for  providing  instructions 
of  any  kind,  including  technical  and  industrial  instruction,  for  any 
person  entitled  to  receive  benefit  under  the  act. 

PURPOSES   AND   METHODS    OF   THE    COMMISSION. 

The  following  account  of  the  purposes  and  methods  of  the  military 
hospitals  commission  is  taken  from  an  official  report: 

The  military  hospitals  commission  was  formed  at  the  instance  of  the  prime  minister* 
the  Right  Hon.  Sir  Robert  L.  Borden,  P.  0.,  G.  C.  M.  G.,  by  order  in  council  dated 
June  30,  1915,  its  powers  being  extended  by  order  in  council  dated  October  12,  1915. 
Following  are  some  of  the  clauses  of  the  commission's  charter: 

1.  That  a  commission,  hereafter  to  be  called  the  military  hospitals  and  convales- 
cent homes  commission,  the  short  title  of  which  shall  be  the  military  hospitals  com- 
mission, be  appointed  to  deal  with  the  provision  of  hospital  accommodation  and  mili- 
tary convalescent  homes  in  Canada,  for  officers,  noncommissioned  officers,  and  men 
of  the  Canadian  expeditionary  force  who  return  invalided  from  the  front,  and  for  offi- 
cers, noncommissioned  officers,  and  men  invalided  while  on  active  service  in  Canada, 
Bermuda,  or  elsewhere. 

2.  That  the  commission  be  empowered  to  select  medical  and  nursing  staffs  and  to 
appoint  such  other  personnel  as  may  be  needed  for  the  management  of  hospitals  and 
homes;  provided  that  a  general  schedule  of  pay  and  allowances  be  submitted  for 
approval  by  the  governor  in  council. 

3.  That  it  be  empowered  to  recommend  to  the  governor  in  council  any  expendi- 
ture which  it  may  consider  necessary  for  the  treatment  and  care  of  the  sick  and 
wounded,  including  the  purchase  of  supplies  and  equipment,  or  for  the  organization, 
administration,  and  maintenance  of  hospitals  and  homes  and  to  expend  any  moneys 
for  the  purposes  and  to  the  amount  authorized  from  time  to  time  by  the  governor  in 
council. 

4.  That  it  be  empowered  to  call  in  the  aid  of  any  department  of  the  Federal  admin- 
istration; in  particular  to  use  the  machinery  of  the  militia  department,  and  where 
doirable  to  draw  on  that  department  for  supplies,  stores,  and  equipment,  and  to 
utilize  the  services  of  divisional  and  district  staffs. 

5.  That  any  expenditure  incurred  by  the  commission  under  the  authority  of  the 
governor  in  council  be  made  a  charge  against  the  war  appropriation  vote,  or  when 
that  ceases  to  be  operative  against  any  other  available  appropriation  made  by  Par- 
liament for  the  purpose. 

6.  That  it  be  empowered  to  accept  such  funds,  bequests,  and  legacies  as  may  be 
given  or  devised  by  individuals  or  corporations  or  others,  with  authority,  subject  to 
the  approval  of  the  governor  in  council,  to  make  all  expenditure  and  to  administer 
any  funds,  bequests,  or  legacies  on  behalf  of  such  members  of  the  Canadian  expedi- 
tionary force  as  in  the  judgment  of  the  commission  may  be  entitled  thereto,  and  for 
the  purpose  of  carrying  out  such  objects  and  purposes  as  may  be  determined  by  the 
commission. 

7.  That  it  be  empowered  to  deal  with  the  question  of  employment  for  members  of 
the  Canadian  expeditionary  force  on  their  return  to  Canada,  and  to  cooperate  with 
provincial  goverments  and  others  for  the  purpose  of  providing  employment  as  may  be 
deemed  necessary. 

The  commission  early  recognized  that  its  work  fell  under  three  main  headings: 

First.  The  provision  of  convalescent  hospitals  and  homes  in  different  parts  of  the 
Dominion. 

Second.  The  provision  of  vocational  training  for  those  who,  through  their  disa- 
bility incurred  in  active  service,  would  be  unable  to  follow  their  previous  occupations. 

Third.  The  establishment  of  the  necessary  machinery  for  the  pro\dsion  of  employ- 
ment for  those  who  require  vocational  training  and  for  those  who  will  during  and  at 
the  conclusion  of  the  war. 

The  forms  on  the  following  pages  are  used  by  the  Canadian  Military 
Hospitals  Commission.  Form  156  is  used  for  making  a  preliminary 
survey  of  all  men.  Form  106  is  used  for  collecting  detailed  informa- 
tion concerning  men  appearing  to  need  vocational  reeducation. 

42297°— S.  Doc.  166,  65—2 4 


50     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 


Form  15f>. 

MILITARY  HOSPITALS  COMMISSION — VOCATIONAL  BRANCH. 
SURVEY  FORM  (PRELIMINARY). 

M.  H.  C,  File  No 

1.  Name Local  file  No 

Address  (present) 

Address  (home) 

Regiment  No Rank Battalion,  C.E.F 

Age  (last  birthday) Birthplace 

If  born  abroad,  date  came  to  Canada Religion 

Nationality  of  father ;  of  mother, Occupation  of  father 

2.  Single,  married,  or  widower Number  of  dependents 

(a)  Applicant's  statement  of  disability 

(6)  Discharged  on Date  of  last  medical  board Place 

3.  EDUCATIONAL  HISTORY. 

Elementary  schooling— 

Where  obtained Kind  of  school Years 

(If  in  more  than  one  place  or  country,  give  time,  etc.,  in  each.) 
Age  on  leaving Grade  or  standard  on  leaving 

Reason  for  leaving 

(Needed  to  earn  money;  preferred  to  go  to  work;  no  higher  school  available,  etc.) 

Subsequent  education — 

NOTE.— State  whether  (1)  high  or  secondary  school,  (2)  technical  or  trade  school,  (3)business  college, 
(4)  college  or  university,  (5)  evening  classes,  (6)  correspondence  school,  (7)  private  study. 

(a)  Name  of  school Place 

Course  taken Years Was  course  completed 

(6)  Name  of  school Place ^ 

Course  taken Years Was  course  completed 

(c)  Name  of  school Place 

Course  taken Years Was  course  completed 

(<?)  Any  other  education 

4.  INDUSTRIAL  HISTORY. 

(a)  Trade  or  principal  occupation How  long  followed 

If  learned  by  apprenticeship,  or  how Average  wage  per  month 

(6)  Trade  or  occupation  at  time  of  enlistment How  long  followed 

(c)  Details  of  employment,  including  (a)  and  (6): 

Occupation.  Employer.  Place.  Period. 

| to.... 

...to... 
! to.... 

,' to-     " 

I  **-• 

I to.... 

i i 

NOTE.— If  "clerk,"  "warehouseman,"  "laborer,"  or  other  general  term,  state  specific  branch. 

Date 19 

(Man's  signature.) 
Interviewed  by 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     51 


Form  106. 
MILITARY  HOSPITALS  COMMISSION — VOCATIONAL  BRANCH. 

SURVEY  FORM. 
A.  General:  M.  H.  C.  File  No 

1.  Name  Local  file  No 

Address  (present)  

Address  (home)  

Regiment  No Rank  Battalion,  C.  E.  F 

Age  (last  birthday) Birthplace  ... 

If  born  abroad,  date  came  to  Canada Religion 

Nationality  of  father ;  of  mother Occupation  of  father  

2.  Man's  dependents—  Name.  Date  of  birth.  Age. 

Wife  

Childrenl 

2 \\\ 

3 \ 

4 

5 

6 

Other  dependents 

3.  EDUCATIONAL  HISTORY.— Elementary  schooling— 

Where  obtained  Kind  of  school  Years  

(If  in  more  than  one  place  or  country,  give  time,  etc.,  in  each.)  " 
Age  on  leaving Grade  or  standard  on  leaving 

Reason  for  leaving 

(Needed  to  earn  money;  preferred  to  go  to  work;  no  higher  school  available,  etc.) 

Subsequent  education. 

NOTE.— State  whether  (1)  high  or  secondary  school,  (2)  technical  or  trade  school,  (3)  business 
college,  (4)  college  or  university,  (5)  evening  classes,  (6)  correspondence  school,  (7)  private 
study. 

(a)  Nameofschool Place 

Coursetaken  Years  Was  course  completed 

(6)  Nameofschool Place 

Course  taken  Years  Was  course  completed 

(c)  NameofSchool  Place 

Coursetaken  Years  Was  course  completed 

(d)  Any  other  education  

4.  INDUSTRIAL  HISTORY. 

(a)  Trade  or  principal  occupation  How  long  followed 

If  learned  by  apprenticeship,  or  how  Average  wage  per  month 

(6)  Trade  or  occupation  at  time  of  enlistment  How  long  followed  

(c)  Details  of  employment  including  (a)  and  (b). 

Occupation.  Employer.  Place.  Period. 

.to. 

.to. 
.to. 
.to. 
.to. 
.to. 

NOTE.— If  "clerk,"  "warehouseman,"  "laborer,"  or  other  general  term,  state  specific  branch. 

Date  ,19 

(Man's  signature.) 
Interviewed  by  


52     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

B.  Report  of  vocational  officer  (reeducation  cases): 
5.  Man's  preference  for  future  occupation — 

First  preference .     Reason  for  it  . . 


Second  preference Reason  for  i  t 


Personal  characteristics— 

(A)  (a)  Recreations (b)  Hobbies 

(c)  Favorite  reading 

(<?)  Habits,  as  drinking (c)  Smoking 

(B)  (a)  Personal  appearance 

(b)  Manner 

(C)  Intelligence  (general  capacity).    Grade 

(D)  Occupational  stability,    (a)  Grade 

(b)  If  candidate  is  changeable,  state  type  of  change 

(c)  Extent  of  change 

(d)  Cause  of  change 

(c)  If  candidate  is  changeable,  has  the  vocational  officer  reasons  for  thinking  that  he  will 
become  stable (/)  If  so,  what? 

(E)  Disposition,    (a)  Sociability (b)  Has   candidate   any   emo- 

tional characteristic  that  the  vocational  officer  would  consider  either  a  business  asset  or  a 
business  handicap? (c)  If  so,  Avhat? 


(F)  (a)  Conduct  on  service (b)  Conduct  in  convalescent  home. 

7.  Training  during  convalescence  (subjects  and  results) 


8.  Type  of  vocations  for  which  ability  and  aptitude  are  evident 

9.  Vocational  officer's  preference  and  reason  for  it 


(a)  Is  a  position  available  for  the  man  on  the  completion  of  his  training  for  the  new  occupation  as 

recommended? 

If  so,  state  where  and  at  what  rate  of  pay 

(b)  If  no  definite  position  is  in  view,  has  the  vocational  officer  satisfied  himself  that  the  prospects 

for  employment  are  good? 

10.  Method  and  place  of  training  recommended 


11.  Estimated  period Tuition  fees,  $ Books  and  materials,  $. 

Date..  >   19----  


(Vocational  officer.) 

NOTE.— Sections  6  to  9  are  to  be  regarded  as  a  confidential  report  of  information  and  impressions  obtained 
bv  the  vocational  officer  during  one  or  more  personal  interviews  with  the  candidate,  or  from  any  other 
sources.  The  information  asked  for  in  section  6,  subsections  (A)  to  (E)  is  to  be  given  in  terms  named  in 
the  confidential  instructions  issued  for  the  guidance  of  vocational  officers. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     53 

C.  Report  of  special  medical  officer: 

12.  Last  medical  board  held  at ,  on ,19 

NOTE.— If  any  medical  boards  have  been  held  since  the  one  at  discharge  depot  on  arrival  in 

Canada,  acopy  of  the  last  board  must  be  sent  with  survey  form  to  head  office  M.  II.  C. 

13.  (a)  Nature  of  disability 

(6)  Nature  of  wound  or  affection  from  which  disability  resulted 

(c)  Date  of  origin (d)Place  of  origin 

14.  Present  physical  condition 

(This  section  must  be  filled  in  as  fully  as  possible.) 


(a)  Height (6)  Weight  (without  overcoat) (c)  Girth,  chest .  I I 

Insp.jExp.  I  Expan. 

15.  Have  any  complications  developed  since  the  holding  of  last  medical  board? 

If  so,  what? 

16.  ( For  amputation  cases) — 

(a)  State  nature  of  amputation,  etc 

(6)  Length  of  stump (c)  Character  of  stump 

(d)  Powerofstump (e)  Usefulness  of  stump 

(/)  What  artificial  appliances  are  required  ?    (0)IIave  any  been  ordered? 

(h)  Have  any  been  received? (/)  Are  any  being  worn? 

17.  (a)  Present  degree  of  incapacity  (stated  in  percentages) (6)  Probable  duration 

(c)  Estimated  degree  of  permanent  incapacity 

NOTE.— In  estimating  incapacity,  the  medical  officer  will  follow  the  instructions  issued  by  the 
board  of  pension  commissioners. 

18.  State  your  reasons  why  candidate  will  be  unable  to  follow  his  former  occupation 


19.  (a)  Will  the  disability  of  the  candidate  handicap  him  in  his  competition  with  the  normal  worker 

in  the  occupation  suggested  by  vocational  officer? 

(b)  If  so,  state  the  manner  in  which  his  disability  will  be  a  handicap 

20.  (a)  Will  candidate's  disability  increase  his  liability  to  hazards  in  the  occupation  suggested  by  vo- 

cational officer? 

(6)  If  so,  state  the  hazard  and  precautions  to  be  observed 

21.  Influence  of  increasing  years,    (a)  Will  candidate  be  able  to  carry  on  as  long  as  the  normal  worker 

in  the  occupation  suggested  by  the  vocational  officer? 

(6)  If  not,  how  much  sooner  may  he  have  to  give  up? 

(c)  State  any  conditions  which,  in  later  life,  may  develop  from  the  candidate's  disability  and  in- 
terfere  with  his  vocational  fitness 

22.  (a)  Will  the  candidate's  condition  demand  any  special  consideration  from  his  employer,  such  as 

shorter  hours,  periods  of  rest,  light  work,  special  type  of  work,  or  machine,  etc? 

(6)  If  so,  what? 


23.  Remarks . 


Date ,  19. ...    Signati 


54     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILOBS. 

D.  Recommendations  of  disabled  soldiers'  training  board: 
24.  .. 


(Vocational  officer.) 
(Medical  member.) 


Place Date ,19....  

(Member  of  local  advisory 

board.) 
E.  (For  head  office  use  only): 

25.  Medical  review.    Are  the  replies  to  sections  17  to  24  herein  concurred  in?  ^ 

If  not,  state  specifically  in  each  case  the  reasons  for  noncoiicurrence 


19....  

(Medical  officer.) 


19....  

(Vocational  secretary.) 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     55 

BELGIUM. 

By  statute  enacted  October  30,  1915,  Belgium  constituted  a 
society  called  "(Euvre  du  travail  des  blesses  belies."  The  purpose 
of  the  society  is  to  sell  at  the  highest  price  the  objects  manufactured 
by  the  Belgian  wounded  soldiers  in  hospitals,  convalescent  depots, 
ami  professional  military  schools  affiliated  with  the  work,  and  to 
uso  the  money  thus  obtained,  together  with  such  other  funds  as 
may  be  received  as  contributions,  for  the  purchase  of  raw  material 
to  be  manufactured  by  the  soldiers  and  also  to  provide  a  fund  to  be 
distributed  to  the  soldiers  and  enable  them  to  establish  themselves 
hi  business. 

AUSTRALIA. 

• 

On  May  30,  1916,  Australia  enacted  the  Australian  soldiers' 
repatriation  fund  act.  Nothing  in  this  act  discloses  how  the  fund 
referred  to  has  been  or  is  to  be  obtained,  the  provisions  of  the  statute 
being  restricted  to  determining  how  the  fund  shall  be  safeguarded 
and  distributed. 

Section  3  provides  that  the  fund  shall  be  invested  in  and  placed 
under  the  control  of  trustees  appointed  by  the  act,  and  section  4 
appoints  a  board  of  trustees,  with  the  prime  minister  at  its  head 
and  prescribes  its  organization.  The  trustees  are  authorized  to 
appoint  an  executive  committee  and  are  charged  with  three  duties: 
(1)  Allocating  to  various  State  war  councils  such  money  or  property 
as  they  shall  determine ;  (2)  investing  in  securities  such  part  of  fund 
as  is  not  immediately  required  for  the  purposes  of  the  fund;  and  (3) 
selling,  or  otherwise  disposing  of,  any  property  forming  portion  of 
receipts  of  fund.  They  are  also  directed  to  forward  to  the  prime 
minister  for  presentation  to  Parliament  an  annual  report  showing 
receipts  and  administration  of  the  funds.  The  State  war  councils, 
to  which  the  trustees  are  authorized  to  allot  money,  are  defined  in 
section  2  to  mean  uin  regard  to  each  State  a  body  appointed  or 
authorized  by  the  governor  and  council  of  that  State  as  the  State 
war  council  and  approved  by  the  governor  general."  Bjr  section  7 
it  is  decreed  that  the  sums  allotted  to  the  State  war  councils  shall  be 
held  upon  trust  to  apply  such  sums,  subject  to  such  conditions  as  may 
be  imposed  by  the  Governor  General  or  the  board  of  trustees,  for 
the  assistance  of  Australian  soldiers  and  their  dependents. 

ITALY. 

On  March  25,  1917,  the  Italian  Government  enacted  legislation 
having  for  its  aim  the  care  and  help  of  disabled  soldiers.  A  summary 
of  a  digest  of  this  enactment  made  by  Bargoni  and  Bernacchi  is  as 
follows : 

1.  The  statute  aims  to  provide,  with  the  assistance  of  the  State, 
complete,  uniform,  and  permanent  help  for  disabled  soldiers.  This 
purpose  is  achieved  through  the  agency  of  a  "national  committee  for 
protection  and  help  of  disabled  soldiers"  (Opera  nazionale  per  la 
protezione  ed  assistenza  degli  invalidi  della  guerra.)  The  committee's 
headquarters  are  in  Rome,  and  it  is  administered  by  a  council  of  19 
members  comprising  2  deputies  and  2  senators,  elected  by  the 


56     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AXD  SAILORS. 

chamber  of  deputies  and  the  senate;  12  members  nominated  by 
royal  decree,  recommended  by  the  president  of  the  council  of  minis- 
ters, including  delegates  from  the  departments  of  the  interior,  war, 
marine,  treasury,  industry,  and  commerce  and  labor,  designated 
by  the  ministers  of  the  departments;  and  representatives  of  com- 
mittees for  the  care  of  war  invalids  and  public  relief  and  pension 
societies;  an  executive  committee  is  elected  by  the  council;  the 
council  elects  its  own  president  and  vice  president  for  terms  of  two 
years;  it  elects  annually  4  members  who,  with  the  president  and 
vice  president,  constitute  the  executive  committee. 

2.  The  act  applies  to  all  disabled  soldiers,  before  and  after  dis- 
charge, and  to  others  discharged  according  to  Italian  military  pension 
laws. 

3.  It  provides  (a)  medical,  orthopedic,  and  prosthetic  assistance 
not   provided   by   military   authorities;  (b)  financial   assistance   in 
special  cases;  (c)  social  assistance  by  primary  technical  education 
or  by  reeducation;  (d)  suitable  situations;  (e)  legal  and  medical  help 
when  needed;  (/)  every  kind  of  assistance,  protection,  and  control 
needed. 

4.  The  work  of  this  committee  depends  upon  the  cooperation  of 
every  public  and  private  institution  or  organization  for  assistance  of 
disabled  soldiers. 

5.  The  committee  coordinates  and  completes  the  work  of  institu- 
tions mentioned  in  4,  and  has  right  to  control  their  actions. 

6.  Discharged  soldiers  continue  work  in  the  army,  or  in  a  private 
or  public  institution,  when  the  doctor  declares  them  fit. 

10.  The  minister  of  interior  will  authorize  in  his  annual  budget  the 
disbursement  of  a  sum  proportionate  to  needs  of  the  national  com- 
mittee. (The  sum  of  1,500,000  lire  is  made  available  for  the  year 
1916-17.  The  office  is  authorized  to  receive  other  funds,  donations, 
and  subventions.) 

12.  After  completion  of  medical  treatment  the  soldier  is  sent  to  a 
special  institution  for  a  technical  reeducation  course,  las  ting,  generally, 
six  months.  (After  six  months  the  national  office  instead  of  the 
military  department  assumes  the  expense  of  a  longer  period  of  train- 
ing-) 

17.  The  cost  of  temporary  or  final  prosthetic  apparatus  is  borne 
by  military  authorities,  and  repairs  are  borne  by  the  national  com- 
mittee. 

19.  Pensions  are  not  affected. 

21.  Loans  for  buying  land  or  establishing  themselves  in  business 
are  made  to  soldiers  on  security  of  pensions. 

22.  Workingmen's  insurance  societies  are  obliged  to  insure   dis- 
abled soldiers  who  have  gone  back  to  work. 

24.  The  Government  is  intrusted  with  the  compilation  of  all 
statistics  relating  to  disabled  soldiers. 

The  minister  of  interior  must  report  annually  to  Parliament  upon 
the  work  of  the  national  office.  It  was  provided  further  that  within 
three  months  of  the  publication  of  this  law,  regulations  for  its  execu- 
tion and  for  the  functioning  of  the  office  should  be  published  in  a 
roval  decree. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.   57 

SOUTH 


South  African  soldiers  disabled  in  service  are  given  reeducation 
and  curative  treatment  at  the  South  African  Military  Hospital  in 
Richmond  Park  near  London.  The  distance  of  South  Africa,  the 
lack  of  modern  artificial  limbs  and  modern  industrial  and  educational 
teaching  in  this  country  makes  rehabilitation  in  England  desirable 
for  the  South  African  soldiers.  While  they  are  undergoing  treat- 
ment at  Richmond  Park  they  are  on  leave  from  the  army  and  receive 
allowances  from  Union  funds  administered  by  the  high  commissioner. 
Over  90  per  cent  of  the  men  who  are  eligible  elect  reeducation.  Such 
training  is  voluntary.  Training  once  elected  is  however  under 
military  discipline.  Reeducation  is  begun  at  the  earliest  possible 
stage  in  convalescence.  As  soon  as  the  South  African  soldier  reaches 
the  hospital,  he  is  put  into  one  of  the  following  classes:  First,  those 
unfit  for  further  active  military  service;  second,  those  whose  fitness 
is  doubtful;  and,  third,  those  who  will  probably  become  fit  on  the 
completion  of  treatment.  Men  in  these  classes  are  given  curative 
treatment  to  enable  them  to  return  to  service  as  soon  as  possible.  If 
the  medical  officer  decides  that  a  patient  will  not  be  able  to  return  to 
active  service  his  reeducation  is  begun  at  once.  The  subjects  taught 
include  those  of  general  education,  bookkeeping,  stenography,  secre- 
tarial work,  metal  and  wood  working  trades,  cinematograph,  and 
electrical  and  engine  work.  A  boot-making  equipment  is  to  be 
added.  As  the  instruction  is  given  by  highly  skilled  teachers,  the 
work  is  not  only  standard  in  every  way  but  unusual  advantages  are 
offered  and  the  men  are  eager  to  avail  themselves  of  the  opportunities. 
Several  have  passed  examinations  of  the  London  Chamber  of  Com- 
merce and  the  National  Union  of  Teachers.  If  a  man's  medical 
treatment  is  completed  and  he  is  discharged  from  the  hospital  before 
he  has  finished  his  vocational  training,  he  lives  at  a  hostel  erected  on 
the  grounds  and  continues  his  course  until  consummated. 

Men  disabled  in  operations  in  Africa  are  cared  for  in  institutions 
in  the  principal  centers  in  the  Union.  Those  who  will  need  artificial 
appliances  are  sent  to  Richmond  Park  where  they  can  undergo 
reeducation  while  waiting  for  the  appliances  to  be  fitted.  "  Every 
man,  however  crippled,  who  passes  through  the  training,  is  treated 
as  a  valuable  asset  to  the  Union,  to  which  he  ultimately  returns  as  a 
soldier." 

On  discharge  the  men  are  entitled  to  the  regular  pension  rates  of 
the  British  troops. 

NEWFOUNDLAND.2 

No  special  institutions  for  reeducation  have  been  required  in  New- 
foundland. When  any  member  of  the  Newfoundland  war  contingent 
is  disabled,  he  receives  such  military  hospital  treatment,  convalescent 
care  and  training  as  is  necessary  in  Great  Britain.  When  he  returns 
to  Newfoundland  he  receives  a  pension  at  colonial  rates  provided  by 
the  Newfoundland  Government.  He  finds  no  difficulty  in  securing 
employment  and  is  readily  absorbed  in  the  general  community. 

1  Recalled  to  Life  No.  2.     Page  271. 

2  Condensed  from  account  in  Recalled  to  Life,  No.  2.    Page  273. 


58     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

INDIA.* 

Detailed  information  of  preparation  for  disabled  soldiers  in  India 
is  not  available.  Queen  Mary's  Technical  School  for  Disabled  Indian 
Soldiers  has  been  established  in  Bombay.  It  accommodates  about 
200  and  is  supported  by  subscriptions  from  various  Indian  funds. 
Reeducation  classes  are  offering  instruction  in  agriculture,  tailoring, 
carpentering,  elementary  engineering,  and  a  machine  shop  is  being 
installed. 

Artificial  limbs  are  provided  in  Bombay,  employment  bureaus  have 
been  established,  and  relief  funds  provide  for  the  men  and  their  fami- 
lies. 

NEW    ZEALAND.2 

There  has  been  established  in  New  Zealand  a  special  department 
of  the  Government  to  obtain  suitable  employment  for  the  returned 
soldier  and  also,  by  any  other  means,  to  assist  in  his  readaptation  to 
civilian  life.  As  most  of  the  men  discharged  from  the  forces  up  to  the 
present  time  are  those  who  have  been  invalided  home  from  the  front, 
it  follows  that  the  major  activity  of  the  discharged  soldiers'  informa- 
tion department  has  been  looking  out  for  the  welfare  of  crippled  and 
disabled  men. 

The  New  Zealanders  have  laid  special  stress  on  the  importance  of 
getting  in  touch  with  every  single  returning  man,  inquiring  regarding 
his  situation,  and  offering  such  assistance  as  is  available.  To  this 
end  arrangements  were  made  for  representatives  of  the  department 
to  board  each  incoming  transport,  and  to  obtain  in  preliminary  form 
from  the  men  themselves  the  items  of  information  desired  for  record. 
Later  on  this  system  was  further  improved  through  arranging  to  have 
the  principal  data  listed  by  the  military  authorities  on  board  the 
transports  while  still  at  sea.  The  information  is  then  completed  by 
the  department's  officers  upon  arrival  in  port,  and  the  cards  for  the 
central  register  are  written  up  without  delay. 

An  important  factor  in  the  department's  work  is  the  chain  of  local 
committees.3  The  personnel  of  these  committees  is  drawn,  almost 
without  exception,  from  influential  citizens  who  are  officers  or  mem- 
bers of  the  local  patriotic  societies.  In  fact  the  committees  are 
often  subcommittees  of  these  societies,  and  if  not  in  this  relation, 
are  in  most  intimate  touch  with  them.  Knowing  the  resources  and 
opportunities  in  their  home  community,  the  members  of  a  local 
committee  are  able  intelligently  to  advise  regarding  the  course  of 
action  in  an  individual  case  under  discussion. 

The  man,  when  first  listed,  is  as  yet  undischarged  and  therefore 
still  under  the  jurisdiction  of  the  defense  department.  So  after 
advice  regarding  the  home-coming  man  is  forwarded  informally  to 
the  local  patriotic  organization,  his  card  is  filed  in  the  central  register 
of  the  returned  soldiers'  information  department  under  the  classi- 
fication "not  ready  for  action." 

i  Condensed  from  account  in  Recalled  to  Life,  No.  2.    Page  273. 

*  Reprint  from  publication  of  the  Red  Cross  Institute  for  Crippled  and  Disabled  Men. 

3  To  date  local  committees  have  been  established  in  the  following  communities  throughout  the  dominion: 


•An&cuici&Af     TT  diigaiinx,   VHOILFV.IIIUJ    XT  ui/iri  t    j-iuot/iiigs,  -ivaililc  vn  K*r,    J  aiiJUfeUclj     rTauWa£/9j     »»  tuiuig i/viiy   -incii 

heim,  Nelson,  Westport,  Greymouth,  Hokitika,  Chris tchurch,  Ashburton,  Timaru,  Oamaru,  Dunedin, 
and  Southland. 


VOCATIONAL  REHAUILITATIOX  OF  DISABLED  SOLDIERS  AXD  SAILORS.     59 

The  military  authoriti--  notify  the  department  a  few  days  in 
advance  of  a  man's  discharge*  from  the  strength,  and  arrangements  are 
thereupon  made  to  have  him  personally  interviewed.  The  local 
police  officials  are  often  delegated  with  the  duty  of  this  visit.  The 
interviewer  is  provided  with  a  blank  report  to  fill  out,  and  with  a 
circular  of  information  to  give  to  the  soldier.  He  is  cautioned  that 
the  inquiries  should  be  made  in  a  sympathetic  spirit,  in  order  that 
there  may  be  formed  a  true  estimate  of  the  man's  needs  and  merits. 
The  form  calls  for  answers  to  the  following  inquiries: 

TO    BE    AXSWERKD    IN    ALL    CA8ES. 

I .  Xarae  and  address  of  soldier.     Is  the  man  of  good  character?    Are  his  surround- 
ings respectable?     Is  he  living  with  relatives,  or  with  whom? 

•2.    Is  he  in  good  health,  or  is  he  still  suffering  from  disease  or  wounds? 

3.  Is  he  tit  for  employment,  and,  if  so.  has  he  obtained  employment,  and  what  are 
his  wages?     If  he  has  not,  does  he  desire  employment,  and,  if  so.  what  kind  of  employ- 
ment does  he  wish  for? 

4.  What  are  his  means  outside  his  wages? 

5.  Has  he  received  assistance  from  any  patriotic  society,   etc.,  and,   if  so,  give 
amounts  and  dates. 

6.  Is  he  receiving  full  military  pay? 

7.  Have  you  handed  the  man  the  information  leaflet  inclosed  herewith? 

TO    BE    ANSWERED    IX    CASES    OP    MEN    AT    PRESEXT    INCAPACITATED,    BUT    LIKELY    TO 

MAKE    A    GOOD    RECOVERY. 

8.  When  is  he  likely  to  be  sound  and  well  and  ready  for  work? 

9.  Is  he  desirous  of  present  employment,  and,  if  so,  what  work  could  he  undertake? 

10.  What  employment  is  he  desirous  of  undertaking  when  restored  to  health? 

TO  BE  AXSWERED  IN  CASES  OF  HEX  FEKMAXEXTLY  DISABLED  BY  SICKNESS  OR  WOUNDS. 

II.  What  is  the  nature  of  his  disablement? 

12.  What  employment  do  you  think  the  man  is  capable  of? 

13.  What  are  his  own  ideas  on  the  subject? 

14.  If  unemployable,  in  what  way  do  you  think  he  could  be  best  assisted? 

15.  Has  he  applied  for  a  war  pension?     If  a  war  pension  has  been  granted,  what 
is  the  amount? 

If  the  man  does  not  require  the  department's  assistance,  please  obtain  his  signature 
here. 

I  do  not  require  the  department's  assistance  in  obtaining  employment. 

(Signature.) 
Any  other  information  which  interviewing  officer  can  supply. 


(Signature.) 
(Date.) 

Very  naturally,  a  considerable  number  of  the/ men  do  not  require 
specific  assistance.  They  may  have  a  business  or  a  farm  to  return 
to  or  be  in  possession  of  private  means.  Others  are  found  to  be 
already  employed  or  to  have  had  emplovment  promised  them.  In 
such  cases  the  man's  record  card  is  transferred  to  the  "disposed  of" 
section  of  the  register. 

The  records  of  men  who  are  under  curative  treatment  and  are  not 
yet  ready  for  employment  are  filed  temporarily  in  the  "  under  action  " 
section  of  the  register.  Except  in  instances  of  systematic  neglect 
to  reply  to  communications,  a  case  is  not  abandoned  until  employ- 
ment shall  have  been  obtained  or  the  office  definitely  informed  that 
its  assistance  is  not  required. 


60     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

Any  inquiries  on  the  part  of  the  men  regarding  land  settlement  or 
pensions  are  referred  to  the  departments  of  the  Government  having 
these  matters  under  jurisdiction. 

Cases  where  the  men  have  applied  for  or  inquired  regarding  em- 
ployment are  regarded  as  active.  In  seeking  positions  to  meet  these 
demands  every  possible  agency  is  employed. 

The  department  has  conducted  a  propaganda  to  secure  preference 
in  employment  opportunity  for  returned  men.  It  has  communicated 
with  local  authorities,  patriotic  organizations,  farmers'  unions,  and 
private  employers  and  has  found  the  response,  on  the  whole,  extremely 
favorable.  The  Government  has  instructed  all  the  departments  that 
ex-members  of  the  expeditionary  force  are  to  be  given  preference  for 
all  vacancies  which  they  are  qualified  to  fill.  The  local  labor  offices 
act  on  the  same  principle.  In  result  a  great  many  men  have  been 
appointed  by  the  public-service  commissioner  or  secured  employment 
by  the  branches  of  the  labor  department.  The  railway  department 
has  helped  to  the  best  of  its  ability,  but  has  itself  been  under  necessity 
of  providing  for  its  own  former  employees  who  have  returned  disabled 
from  the  front. 

The  man  desirous  of  obtaining  employment  is  instructed  to  get  in 
touch  with  the  local  committee  in  his  home  district.  The  case  is  then 
charged  against  the  committee  on  the  record  of  the  department.  If 
necessary,  there  are  sent  periodical  reminders  inquiring  regarding 
progress  and  advising  of  any  apparently  suitable  vacancies  which 
have  come  to  the  knowledge  of  the  central  office.  The  department 
communicates  to  the  committees  all  offers  of  employment  which  come 
to  its  notice.  In  the  case  of  new  offers  it  makes  an  inspection  of  the 
cases  charged  against  the  committee  in  the  locality  where  the  work 
is  available  and  telegraphs  this  committee,  directing  attention  to  and 
men  who  seem  suitable  candidates  for  the  vacancies. 

The  department  keeps  a  double  card  index  of  the  men  awaiting 
employment.  One  set  of  cards  is  classified  according  to  occupation; 
a  second  according  to  district  of  residence.  Offers  of  employment  are 
likewise  suitably  indexed. 

A  statement  indicating  the  number  of  candidates  for  employment 
in  each  district  is  sent  out  weekly  to  the  local  committees.  This 
serves  as  a  check  on  their  number  of  open  cases,  and  incites  friendly 
rivalry  between  the  committees  to  keep  down  the  number  charged 
against  them. 

Up  to  June  21,  1917,  the  total  number  of  men  who  had  been 
registered  by  the  department  was  9,070.  This  number  included  the 
general  type  of  invalid  as  well  as  the  men  physically  disabled.  The 
cases  were  subject  to  the  following  classification: 

Cases  disposed  of:  Placed  in  employment,  returned  to  military  duty,  or  their 
old  employment,  or  signed  a  statement  that  they  do  not  require  the  depart- 
ment's assistance 7,  298 

Cases  under  action:  Department  making  inquiries  on  the  soldier's  behalf  or 
awaiting  notice  of  discharge 881 

Cases  not  ready  for  action:  Men  recently  returned  to  New  Zealand,  now  con- 
valescing, not  ready  for  employment,  or  not  yet  discharged  by  the  military 
authorities G92 

Open  cases:  Men  for  whom  employment  is  desired 

Total..,  9,070 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.      61 

The  results  in  an  effort  to  provide  special  training  or  reeducation 
for  disabled  men  have  not,  on  the  whole,  been  encouraging.  Although 
the  opportunities  are  brought  systematically  to  the  attention  of  the 
men  the  response  has  been  indifferent.  But  the  work  is  as  yet  new, 
and  there  are  several  factors  that  seem  in  some  degree  to  account  for 
the  situation. 

For  agricultural  training,  arrangements  have  been  made  with  the 
agricultural  department  to  accept  a  limited  number  of  men  for 
instruction  at  the  state  farms.  Among  the  various  branches  of  farm 
work  are  dairying,  fruit  farming,  cropping,  poultry  raising,  bee  cul- 
ture, and  market  gardening.  In  scientific  training  in  agricultural 
and  pastoral  subjects  the  authorities  of  Lincoln  College,  Wellington, 
have  placed  at  the  disposal  of  ex-soldiers  five  scholarships  of  £20 
each,  and  have  agreed  to  take  nonresident  pupils  at  a  nominal  fee. 
In  deserving  cases  the  returned  soldiers'  information  department  is 
prepared  to  supplement  the  scholarship  grants  by  an  adequate  annual 
allowance.  Few  soldiers  have  taken  advantage  of  the  opportunities 
for  agricultural  training. 

Clerical  training  for  disabled  soldiers  is  being  provided  free  of 
expense  to  the  Government  or  the  men  by  the  New  Zealand  Society  of 
Accountants.  The  subjects  covered  are  those  prescribed  for  the 
society's  bookkeeping  examination.  The  examination  fees  of  pupils 
prepared  to  sit  at  the  university  examinations  in  accountancy  are 
also  met  by  the  society.  In  addition  to  the  classroom  instruction 
courses  are  also  given  by  correspondence  for  the  benefit  of  men  who 
can  not  attend  in  person. 

According  to  the  annual  report  of  the  returned  soldiers'  informa- 
tion department,  "  a  considerable  number  of  men  have  from  time,  to 
time  entered  for  the  classes,  but  it  is  understood  that  with  few  ex- 
ceptions the  attendance  has  been  desultory  and  the  progress  poor,  and 
it  has  lately  been  intimated  to  the  department  by  the  secretary  that 
the  council  of  the  society  is  now  considering  whether  it  is  justified  in 
continuing  the  expenditure  of  some  hundreds  of  pounds  for  such 
unsatisfactory  results.  The  matter  is  unquestionably  one  for  very 
profound  regret,  the  scheme  having  originally  been  adopted  by  the 
society  on  its  own  initiative  and  promising,  as  we  all  hoped,  very 
valuable  developments." 

For  disabled  men  who  can  not  return  to  their  former  occupations 
there  is  offered  free  tuition  at  various  technical  schools  throughout 
New  Zealand.  At  the  Wellington  Technical  College,  for  example, 
instruction  is  provided  in  building  construction,  painting,  decoration, 
and  sign  writing,  carpentry  and  joinery,  plumbing,  machine  work, 
jewelry  making,  metal  work,  plastering,  and  modeling.  At  other 
instruction  centers  there  are  different  curricula.  In  June,  1917,  69 
men  were  taking  training  at  technical  schools. 

By  arrangement  with  the  Jubilee  Institute  for  the  Blind  training  is 
provided  for  men  partially  or  totally  blinded  at  the  front. 

To  remove  any  possible  financial  obstacle  to  men  desiring  to  under- 
take training,  the  Government  some  time  ago  decided  to  grant  main- 
tenance allowances  not  in  excess  of  £  1  a  week,  irrespective  of  pension 
payments,  to  men  attending  classes.  These  allowances  are  condi- 
tioned only  upon  approval  of  the  training  subject  as  suitable  to  the 
individual  case  and  upon  good  conduct,  regular  attendance,  and  sat- 
isfactory progress. 


62     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

Related  to  the  question  of  training  for  men  unable  to  follow  their 
former  trade  is  that  of  allowing  disabled  men  to  accept  positions 
with  private  employers  at  rates  of  pay  less  than  those  fixed  by  current 
awards  or  agreements  and  minimum  wage  legislation.  The  subject 
was  taken  up  by  the  labor  department  early  in  1916,  and  under  an 
order  in  council  then  approved,  14  under-rate  permits  prescribing 
weekly  wages  of  from  £2  10s.  to  £1  15s.  have  been  issued. 

The  establishment  of  special  reeducational  institutions  for  war 
cripples  has  been  urged  by  various  individuals  and  organizations. 
The  recommendation  has  elicited  from  the  minister  in  charge  of  the 
returned  soldiers'  information  department  the  following  comment: 

During  the  last  few  weeks  the  question  of  the  establishment  of  special  training 
colleges  for  disabled  men  has  been  urged  on  the  attention  of  the  department.  The 
gentlemen  concerned  in  this  movement  have  shown  most  praiseworthy  interest  in 
the  welfare  of  our  returned  men,  and  which,  in  so  far  as  it  manifests  a  lively  interest 
in  our  soldiers,  must  command  the  sympathy  and  respect  of  us  all.  I  gather  from  the 
correspondence  which  has  come  under  my  notice  that  the  promoters  of  the  scheme 
have  in  mind  the  provision  of  training  colleges  and  farms  for  men  still  undergoing 
hospital  treatment,  and  if  this  is  correct  the  question  more  properly  appertains  to  the 
work  of  the  department  of  public  health  than  to  the  discharged  soldiers'  information 
department.  So  far  as  the  latter  department  is  concerned,  I  regret  that  I  can  not  at 
present  see  my  way  to  support  a  scheme  of  the  character  suggested.  The  small  extent 
to  which  existing  facilities  have  been  availed  of  would  not,  in  my  opinion,  justify  the 
large  expense  which  the  institution  of  special  training  colleges  with  expensive  build- 
ings, apparatus,  and  staff  would  involve.  I  am  supported  in  this  view  by  the  attitude 
taken  up  by  the  statutory  war  pensions  committee,  which  has  been  established  by 
legislation  in  the  United  Kingdom,  and  which  amongst  other  functions  deals  with 
the  training  and  employment  of  disabled  men.  In  addressing  its  local  committees 
on  this  particular  subject  it  urges  them  to  make  use  as  far  as  possible  of  existing  in- 
stitutions, speciiically  mentioning  the  technical  schools,  and  adds  that  "as  the  num- 
ber of  men  for  whom  training  is  needed  will  diminish  year  by  year  after  the  war, 
expenditure  on  the  provision  of  buildings  and  apparatus,  whiclTwill  only  be  required 
for  a  temporary  period,  should  be  kept  within  strict  limits." 

In  addition  to  the  foregoing,  I  doubt  whether  an  institution  of  the  character  pro- 
posed, involving  a  considerable  measure  of  control  and  discipline,  would  be  appre- 
ciated by  the  men  for  whose  benefit  it  is  designed.  I  am  inclined  to  think  that  the 
younger  men  would  before  very  long  find  the  necessary  restraint  distasteful  and  irk- 
some. In  this  opinion  I  am  supported  by  the  views  of  a  prominent  member  of  the 
medical  profession  in  New  Zealand — one  who  I  may  say  has  had  special  opportunities 
of  forming  an  opinion  through  daily  contact  with  the  inmates  of  one  of  our  large  con- 
valescent homes.  Speaking  on  this  very  subject  of  a  training  college  for  men  out 
of  or  nearly  out  of  the  doctor's  hands,  he  says,  "I  am  a  little  dubious  as  to  whether 
the  men  would  be  content  to  remain  long  under  institutional  control;"  and  again, 
"I  feel  sure  that  the  feeling  of  independence  from  control,  impossible  in  any  institu- 
tion, is  an  essential  factor  in  any  scheme  designed  to  appeal  to  the  average  man,  and 
not  to  the  exceptional  returned  man."  I  am  entirely  in  accord  with  these  views, 
and  for  the  reasons  given  I  could  not,  for  the  present  at  any  rate,  see  my  way  to  support 
the  schemes  which  have  been  put  forward. 

While  the  experience  in  the  matter  of  training  has  been  disap- 
pointing, the  results  in  obtaining  employment  for  disabled  men  have 
been  unusually  successful.  The  latter  may  go  far  to  explain  the 
former,  especially  in  view  of  the  great  present  demand  for  labor  in 
New  Zealand,  and  the  natural  desire  on  the  part  of  the  men  to  get 
back  at  once  to  remunerative  and  productive  occupation. 

The  amount  of  pension  award,  based  as  it  is  on  medical  evidence 
as  to  physical  condition,  is  a  fair  criterion  of  the  extent  of  disability. 
A  tabulation  has  been  prepared  showing  the  number  of  men  drawing 
pensions  of  £1  5s.  per  week  and  upward  for  whom  the  returned 
soldiers'  information  department  obtained  remunerative  employ- 
ment. As  loss  of  sight  in  one  eye  carries  with  it  a  pension  of  £1  per 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.    63 

week  it  is  evident  that  the  range  of  pensions  represented  in  the 
tabulation  embrace  only  cases  of  grave  disability.  A  summary  of 
this  tabulation  gives  the  following  totals: 

Weekly  pension:  Number  of  placements. 

£  1    5s.  Od 80 

£  1  10s.  Od 146 

£  1  15s.  Od 47 

In  some  amputation  cases  the  placement  results  were  as  follows: 


Amputation. 

Pension. 

Employment. 

Amputation. 

Pension. 

Employment. 

Left  thigh. 
Right  arm. 
Left  foot... 
Left  knee 

£.  s.  d. 
1  15  0 
1  15  0 
1  15  0 
1  15  0 

Artificial  limb  making. 
Storeman. 
Draftsman. 
Artificial  limb  making. 

Left  leg  

Right  foot... 
Leg 

£.    s.  d. 
1    15    0 

1    10    0 
1    10    0 

Night  exchange  attend- 
ant. 
Land  officer. 
Mechanic 

Right  arm. 
Left  arm  .  . 

1  15  0 
1  15  0 

Niglxt  watchman. 
Fruit  farming. 

Right  foot... 
Le  fit  leg 

1    10    0 
1     10    0 

basket  maker. 
Clerical  position 

Right  leg... 

1  15  0 

Clerk. 

Two  fingers.. 

1      5    0 

Messenger. 

To  Hon.  A.  L.  Herdman,  the  minister  in  charge  of  the  returned 
soldiers'  information  department,  I  am  indebted  for  the  information 
and  documentary  material  on  which  this  memorandum  is  based. 


PART  III. 
THE  SIZE  OF  THE  PROBLEM. 

SOME  FACTORS  TO  BE  TAKEN  INTO  CONSIDERATION  IN  ESTIMATING 
THE  NUMBER  THAT  WILL  REQUIRE  VOCATIONAL  REEDUCATION. 

Any  estimate  of  the  number  of  men  returning  disabled  and  of  the 
number  requiring  vocational  reeducation  must  be  based  upon  certain 
assumptions  regarding  the  duration  of  the  war,  the  number  of  men 
maintained  at  the  front,  and  the  proportion  of  casualties. 

Obviously  no  forecast  of  the  progress  of  the  war  can  be  made,  and, 
obviously,  the  ratio  of  casualties  to  men  mobilized  may  increase  or 
decrease  in  the  coming  years. 

In  France  the  ratio  of  casualties  was  highest  during  the  opening 
period  of  the  war,  in  which  the  battles  of  Charleroi  and  the  Marne 
were  fought.  In  each  six  months  of  the  years  1915  and  1916  the  ratio 
of  casualties  to  men  mobilized  in  the  French  Army  declined  from 
2.39  per  cent  in  the  first  six  months  of  1915,  to  1.68  per  cent  in  the 
six  months  following,  to  1.47  per  cent  in  the  first  half  of  1916,  and  to 
1.28  per  cent  in  the  latter  half  of  that  year. 

It  would  be  unsafe  to  assume  that  this  decline  in  the  ratio  will  con- 
tinue. It  is  entirely  conceivable  that  developments  and  changes  dur- 
ing the  coming  years  will  produce  on  the  contrary  much  higher  ratios. 

It  appears  that  the  killed  in  action  and  died  of  wounds  have  not 
exceeded  one-fifth  of  the  total  casualties.  Approximately  four-fifths, 
therefore,  survive.  Some  among  these  recover  completely,  develop- 
ing 100  per  cent  of  their  former  vocational  efficiency;  some  recover 
partial  efficiency  in  their  old  employment;  some  are  incapacitated 
totally  for  their  old  employment  but  are  capable  of  greater  or  less 
efficiency  in  other  employments,  provided  they  be  given  the  voca- 
tional training  required  to  overcome  their  specific  handicap;  some  are 
totally  incapable  of  any  sort  of  vocational  training  or  activity. 

It  should  be  borne  in  mind  that,  in  accordance  with  present  prac- 
tice in  the  military  hospitals  of  Europe — as  of  some  hospitals  in  this 
country — vocational  training  begins  during  the  period  of  conva- 
lescence, in  a  curative  workshop  attached  to  the  hospital.  Such 
training,  described  technically  as  "  occupational  therapy,"  is  not 
reserved  for  men  who  will  eventually  develop  vocational  capacity 
insuring  economic  independence  in  the  competitive  labor  market. 
It  has  become  a  recognized  part  of  therapeutic  treatment.  In  a 
report  of  the  military  hospitals  commission  of  Canada,  made  in  May, 
1917,  it  is  noted  that  while  it  had  been  thought  that  a  majority  of 
the  men  returned  from  the  war  "  would  require  rest  and  recreation/' 
it  was  found,  by  experience,  that  what  they  did  in  fact  require  was 
"  active  therapeutic  and  orthopaedic  treatment." 

42297°— S.  Doc.  166,  65-2 5  65 


66     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

In  providing  this  active  treatment  along  occupational  lines  the 
vocational  expert  cooperates  with  the  physician  to  achieve  the  con- 
valescence of  the  patient.  In  this  field  vocational  training  is  given 
as  therapeutic  discipline,  and  is  not  necessarily,  though  it  should  be 
generally  related  as  far  as  possible  to  the  subsequent  vocational 
career  of  the  patient. 

For  some  men  the  vocational  training  will  terminate  when  they 
are  discharged  from  the  hospital  cured.  For  others  the  vocational 
training  initiated  during  convalescence  will  necessarily  be  continued 
after  that  period,  or  some  new  line  of  training  will  be  initiated.  In 
these  cases  a  longer  or  shorter  period  of  intensive  vocational  training 
will  follow  convalescence. 

When  the  statement  is  made  that  4,  5,  or  10  per  cent  of  the  men 
disabled  will  require  vocational  reeducation,  the  proportion  relates 
to  those  men  disabled  for  further  military  service,  and  returned 
therefore,  to  civil  employments. 

While,  however,  the  proportion  requiring  vocational  reeducation 
is  relative  to  the  number  "of  disabled  and  invalided  men,  this  propor- 
tion itself  may  be  very  materially  affected  by  the  policy  of  rehabili- 
tation adopted. 

If  every  sort  of  training  is  provided  that  can  be  given  with  material 
i,  the  proportion  of  cases  for  vocation  ' 
;her  than  if  a  policy  is  adopted  of  unc 
ly  where  such  training  is  obviously 
and  unavoidable  if  the  man  is  to  acquire  any  sort  of  wage-earning 
capacity.  In  a  word,  the  proportion  of  cases  for  vocational  training 
will  be  relatively  large  or  small  according  as  the  provision  for  voca- 
tional reeducation  is  ample  and  complete  or  partial  and  special,  being 
restricted  in  the  latter  case  to  a  minimum  of  cases  and  to  a  small 
number  of  vocations. 

Capability  for  vocational  reeducation  is  in  no  case  an  absolute  and 
definite  capacity  which  may  be  accurately  measured  with  reference 
to  individuals.  Most  disabled  men  will  be  more  or  less  capable  of 
special  training  and  the  number  actually  trained  will  depend  upon 
the  educational  facilities  created. 

A  small  proportion  of  the  men  returned  will  be  totally  disabled; 
incapable,  therefore,  of  beiifiting  in  any  degree  from  any  sort  of 
training.  A  larger  proportion,  perhaps  four-fifths,  will  be  entirely 
able  to  reenter  their  former  occupations  without  any  training.  Some 
will  be  helped  materially  by  systematic  reeducation  in  their  old  em- 
ployment to  overcome  special  handicaps,  some  will  require  training 
in  absolutely  new  employments,  some — including,  for  example,  men 
who  have  contracted  tuberculosis,  where  the  former  occupation 
would  subject  them  to  unfavorable  conditions — may  be  greatly  ben- 
efited by  training  for  some  other  employment  in  which  their  handicap 
will  be  less  serious. 

It  need  not  be  assumed  that  conditions  will  suddenly  develop  in 
the  United  States  corresponding  to  those  which  now  obtain  in 
Europe — in  Germany,  for  example,  where  it  is  reported,  500,000 
men  are  constantly  under  treatment  in  hospitals,  the  number  of  leg 
amputations  alone  in  1916  being  16,000;  or  in  France,  where  accord- 
ing to  figures  published  by  the  national  office  for  disabled  soldiers, 
6,000  or  7,000  soldiers  are  newly  pensioned,  discharged,  or  disabled 
each  month;  or  in  any  other  of  the  European  countries  which  now 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.    67 

report  an  aggregate  of  13,000,000  wounded  and  disabled  men.  But 
conditions  similar  to  these — which  are  the  immediate  consequence 
of  only  three  years  of  war,  may  very  well  develop  in  this  country  if 
the  war  continues  for  another  period  of  three  years — and  even 
worse  conditions  are  easily  within  the  range  of  possibility. 

Experience  in  European  belligerent  countries  during  the  past  three 
years  can  not  be  accepted  as  establishing,  with  any  considerable 
degree  of  certainty,  disability  ratios  for  the  future  in  the  fighting 
forces  either  of  these  countries  themselves,  or  in  the  overseas  forces 
of  the  United  States.  But  higher  as  well  as  lower  casualty  and 
disability  ratios  are  conceivable,  and  even  with  much  lower  ratios, 
the  problem  confronting  the  United  States  is  sufficiently  serious. 

Some  inferences  may  be  drawn  from  Canadian  experience,  always 
with  the  reservation  that  the  margin  of  error  in  these  inferences,  so 
far  as  regards  future  developments  in  the  United  States,  may  be 
very  large. 

The  following  table  (Table  1),  showing  the  number  of  disabled 
men  returned  to  Canada  monthly,  is  reproduced  from  the  report  of 
the  Canadian  military  hospitals  commission  (May,  1917).  It  in- 
cludes only  the  men  whose  records,  had  up  to  March  31,  1917,  been 
analyzed,  and  it  is  to  be  noted,  further,  that  only  the  more  seriously 
disabled  men  have  been  returned  to  Canada. 

TABLE  1. — Number  of  men  returned  to  Canada  by  months. 


Month. 

1915 

1916 

1917 

Month. 

1915 

1916 

1917 

January 

64 

150 

1.569 

August 

93 

509 

February 

(i) 

182 

868 

September 

226 

636 

March... 

(i) 

343 

2  151 

October. 

703 

1  551 

April 

w 

396 

November 

977 

1  0*0 

Mav. 

47 

476 

December. 

228 

784 

June 

36 

278 

No  record 

139 

16 

July  

96 

268 

Total  Jan.  1, 1915,  to  Mar.  31, 1917 13,826. 

1  No  record. 

In  Table  2  these  men  are  classified  according  to  the  degree  of 
disability  awarded  by  the  medical  board  at  the  port  of  their  disem- 
barkation. 

TABLE  2. — Returned  men  classified  according  to  the  degree  of  their  d-isability. 


Degree  of  disability. 

Men. 

Distri- 
bution. 

Degree  of  disability. 

Men. 

Distri- 
bution. 

Total  men  returned  

Disability: 
0-25  per  cent  . 

Number. 
13,826 

7,418 
2,923 

Per  cent. 
100.00 

53.65 
21.14 

Disability  —  Continued. 
51-75  per  cent  

Number. 
927 
l,97o 
583 

Percent. 
6.71 
14.28 
4.22 

79-100  per  cent 

26-50  per  cent  

No  record 

68     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILOBS. 

Kecent  figures  covering  Canadian  experience  are  given  in  the 
following  statement: 

Total  number  returned  to  date,  Oct.  31, 1917,  approximate,  all  classes,  includ- 
ing undesirables,  etc 'm 26, 000 

Total  Canadian  blind  in  England  and  returned '.'.       '   32 

Total  amputations  among  men  returned : 

Legs 632 

Arms : 285 

In  4,000  cases  surveyed  recently  the  number  found  to  be  nervous  and  mental  cases 

was  400,  or  10  per  cent. 

Of  these  400— 

60  per  cent  were  suffering  from  nervous  troubles 240 

25  per  cent  were  mental  cases 100 

15  per  cent  were  epileptic 60 

Number  of  total  insane  to  date 273 

Total  number  of  patients  in  hospitals,  etc. : 

On  Mar.  31,  1916 1  305 

On  Sept.  30,  1916 1877 

On  Mar.  31,  1917. 4  880 

On  Oct.  31,  1917 10, 199 

The  number  of  invalided  men  on  the  strength  of  the  Canadian  military  hospitals 
commission  was  6,515  on  May  8,  1917,  having  increased  from  2,365  on  December  31. 
1916. 

In  November,  1917,  the  vocational  branch  of  the  commission  had  interviewed 
3,756  cases,  had  surveyed  vocationally  1,766  cases,  and  had  approved  courses  for 
1,452  cases.  The  number  taking  current  courses  of  vocational  training  was  approxi- 
mately 1,200. 

The  disposition  of  the  cases  surveyed  was  as  follows: 

Total  surveyed 1,  766 

Pending  information 108 

Pending  result  of  treatment 30 

Noneligible  cases 176 

Courses  approved 1, 452 

The  latest  report  of  Canadian  experience  1  states  that  approx- 
imately 10  per  cent  of  the  Canadian  forces  overseas,  29,800  out  of 
300,000,  have  been  returned  as  unfit  for  military  service;  approx- 
imately one-third  of  these,  9,000  out  of  the  29,800,  being  in  the 
hospitals  at  one  time. 

Of  the  men  returned  unfit  for  military  service,  80  per  cent,  or 
four-fifths,  return  to  their  former  occupations  without  vocational 
training  or  are  incapable  of  such  training,  and  20  per  cent  require 
vocational  training.  One-half  of  those  requiring  vocational  train- 
ing— i.  e.,  10  per  cent  of  those  returned  unfit  for  military  service- 
require  complete  vocational  reeducation,  and  one-half  partial  voca- 
tional reeducation. 

That  is  to  say,  Canadian  experience  to  date  indicates  that  with 
300,000  men  overseas  6,000  men  have  been  returned  unfit  for  military 
service  and  requiring  complete  or  partial  vocational  reeducation.  This 
number  does  not  represent  300,000  men  at  the  front  for  the  whole 
period  of  the  war,  since  the  number  of  men  at  the  front  has  been 
only  gradually  brought  up  to  300,000  during  the  period  of  the  war, 
there  being  comparatively  few  Canadians  in  the  trenches  at  the 
outset. 

Accepting  these  ratios  as  significant  for  the  over-seas  forces  of  the 
United  States,  and  assuming  that  the  United  States  will  send  over 

i  Report  of  F.  B.  Magbuson  to  Mr.  Samuel  Insull,  State  counsel  of  national  defense  of  Illinois. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     69 

1,000,000  men  the  first  year,  and  will  increase  its  expeditionary  force 
by  1,000,000  each  year  for  the  duration  of  the  war,  the  following 
deductions  are,  perhaps,  warranted,  as  forecasting  conditions  at  the 
close  of  one  year  of  fighting. 

Number  of  men  overseas 1, 000, 000 

Number  of  men  returned  unfit  for  military  service 100,  000 

Number  not  requiring  vocational  reeducation 80, 000 

Number  requiring  vocational  reeducation: 

( 'omplete 10, 000 

Partial 10,  000 

Iii  a  word,  for  each  million  men  overseas  it  may,  perhaps,  fairly  be 
expected  that  100,000  men  will  be  returned  each  year,  of  whom  20,000 
will  require  complete  or  partial  vocational  reeducation.  This  number 
of  men  may  in  fact  be  in  hand  to  be  provided  for  by  the  close  of  the 
summer  campaign  of  1918. 

But  long  before  the  close  of  activities  in  the  summer  of  1918  the 
return  of  men  will  begin,  and  vocational  reeducation  must  start  with 
the  first  men  sent  back,  and  must  be  developed  as  the  number  of  men 
in  hand  for  training  increases.  The  development  of  facilities  for 
undertaking  vocational  reeducation  must,  in  fact,  anticipate  the 
return  of  the  men,  since  adequate  provision  can  not  be  improvised 
after  the  men  are  actually  in  hand  for  training. 

As  regards  numbers  to  be  vocationally  reeducated,  Canadian  expe- 
rience would  appear  to  indicate  20,000  for  the  first  year,  40,000  • 
additional  for  the  second  year,  and  60,000  additional  for  the  third 
year,  and  aggregate  for  three  years  of  war  of  120,000  men. 

Immediate  provision  should  be  made  for  the  training  during  1918 
of  at  least  20,000  men.  In  the  second  year  of  fighting,  on  the  above 
assumption,  the  discharges  from  the  military  hospitals  will  provide 
each  month  between  3,000  and  4,000  candidates  for  vocational 
training,  and  in  each  month  of  the  third  year  of  the  fighting  approxi- 
mately 5,000  candidates. 

If  the  vocational  training  course  averages  six  months  per  man, 
the  number  of  men  actually  in  training  may  be  roughly  estimated 
to  be  10,000  at  the  close  of  one  year  of  fighting,  20,000  at  the  close 
of  the  second  year,  and  30,000  at  the  close  of  the  third  year. 

The  training  and  organization  of  a  staff  of  teachers  for  this  work 
will  constitute  a  large  factor  in  the  problem  of  vocational  education. 

It  should  be  noted,  however,  that  the  above  calculation  is  based 
upon  rather  meager  accounts  of  Canadian  experience,  and  that  pro- 
portions as  low  as  4  or  5  per  cent  of  the  disabled  men  returned  have 
been  indicated  as  the  proportion  of  men  requiring  vocational  re- 
education. If  this  range  of  estimate  is  taken  into  account,  the 
number  of  men  requiring  vocational  reeducation  during  the  first  year 
of  the  war  may  fall  as  low  as  4,000  or  5,000  per  million  men  overseas. 
But,  on  the  other  hand,  as  has  been  noted,  experience  in  past  years 
of  the  war  does  not  necessarily  measure  the  maximum  possibility  of 
casualties,  nor  does  it  necessarily  measure  the  maximum  provision 
for  vocational  reeducation  either  in  Canada  or  in  any  European 
country.  It  is  highly  probable  that  in  very  many  instances  voca- 
tional reeducation  has  not  been  undertaken  where  such  training 
would  be  of  real  value  to  the  disabled  man,  and  would  in  fact  /be 
economically  advantageous  to  the  community. 


70     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

In  the  fiscal  year  1916-17  the  expenses  of  the  vocational  branch  of 
the  Canadian  hospitals  commission,  including  cost  of  maintenance 
of  men  undergoing  reeducation,  amounted  to  $83,669.99  out  of  total 
disbursements  by  the  commission  in  the  same  period  of  $1,484,048.90. 

Maintenance  is  provided  for  the  men  and  their  dependents  during 
the  period  of  their  vocational  reeducation. 

The  following  paragraphs,  quoted  from  the  report  of  the  Canadian 
military  hospitals  commission,  indicate  briefly  the  steps  which  have 
been  taken  in  Canada  for  the  vocational  rehabilitation  of  returned 
men,  and  indicate  by  inference  the  dimensions  of  the  problem 
immediately  confronting  the  United  States. 

One  of  the  problems  taken  up  in  the  early  stages  of  the  commission's  work  was  the 
provision  of  vocational  training  for  the  men  in  the  hospitals,  and  reeducation  for  those 
unable  to  follow  their  previous  occupations  after  discharge.  It  was  realized  that  this 
was  a  most  complex  problem.  No  precedents  were  available  to  guide  the  commission, 
although  it  was  known  that  a  great  deal  of  work  was  under  way  in  France  along  these 
lines,  and  reports  had  been  received  from  Dr.  Bourillon  and  others,  but  these  did  not 
appear  to  fit  the  situation  in  Canada.  The  director  of  technical  education  for  Nova 
Scotia,  now  vocational  officer  for  the  commission  for  the  Maritime  Provinces  and 
Quebec,  also  prepared  a  valuable  report.  It  was  found  that  vocational  training  in  the 
hospitals  was  necessary  not  only  because  of  its  educational  ^value  but  because  of  its 
therapeutic  value.  Men  who  are  occupied  recover  more  quickly  than  those  who  are 
idle.  The  disability  of  a  soldier  in  a  hospital  naturally  preys  on  his  mind  and  self-pity 
grows  in  him.  Some  men  also  have  the  feeling  that  haying  suffered  for  their  country 
they  should  not  be  required  to  exert  themselves  For  their  livelihood,  but  that  the  country 
owes  them  a  livelihood.  This  is  only  partially  true.  What  the  country  owes  to  these 
men  is  an  opportunity  to  obtain  a  livelihood.  The  problem,  therefore,  which  pre- 
sented itself  was  how  to  raise  the  disabled  again  and  to  alleviate  their  lot  by  restoring 
to  them  that  joy  of  life  which  comes  from  the  feeling  of  renewed  capacity  to  work  and  of 
mastery  over  themselves  and  their  disabilities. 

The  work  was  commenced  actively  by  the  appointment  of  a  vocational  secretary 
in  January,  1916.  It  was  at  the  beginning  largely  experimental.  One  of  the  first 
things  undertaken,  therefore,  was  a  survey,  at  widely  separate  parts  of  Canada,  of 
typical  groups  of  patients  in  the  convalescent  hospitals.  Amongst  other  facts  ascer- 
tained was  the  cheering  one  that  the  proportion  of  men  who  were  so  disabled  as  not 
to  be  able  to  return  to  their  previous  occupations  was  comparatively  small.  Since 
then  figures  have  been  obtained  from  France  where  this  proportion  is  stated  to  be  less 
than  1  per  cent  of  the  wounded.  It  is  not  possible  yet  to  give  any  definite  percentage 
for  the  men  in  Canada,  but  as  only  the  more  seriously  disabled  have  been  returned  so 
far,  the  percentage  will  probably  be  higher  than  that  in  France,  which  covers  appar- 
ently the  whole  of  the  wounded. 

At  the  commencement  of  the  work  in  the  hospitals,  classes  in  general  subjects 
were  established,  in  which  those  who  desired  to  do  so  might  brush  up  their  education 
or  take  up  new  subjects.  One  of  the  earliest  classes  to  be  opened  was  for  the  teaching 
of  English  to  foreign-born  members  of  the  Canadian  expeditionary  force,  of  whom  a 
number  had  been  returned.  More  from  a  recreative  than  from  the  vocational  point 
of  view,  instruction  in  the  simple  work  of  the  arts  and  crafts  was  also  introduced. 
This  work  often  involved  drafting  and  led  to  the  installation  of  apparatus  for  and 
instruction  in  mechanical  and  architectural  drawing.  In  practically  every  center 
the  classes  in  general  subjects  soon  developed  a  distinct  commercial  side  in  which 
shorthand,  typewriting,  bookkeeping,  and  related  branches  are  taught.  There  is 
a  considerable  demand  for  male  help  in  these  lines,  and  men  slightly  disabled  have 
been  able  to  qualify  for  clerical  positions  in  this  way.  Thanks  to  the  cooperation  of 
the  civil-service  commissioners,  classes  to  prepare  men  for  civil-service  examinations 
have  been  organized  at  several  of  the  principal  centers.  Examinations  were  held  in 
September,  1916,  when  11  passed;  in  December,  1916,  when  45  passed;  and  in  March, 
1917,  when  140  passed.  These  were  for  the  lower-grade  inside  service.  A  number 
of  men  are  preparing  for  the  second-grade  examination  in  May. 

*  *  *  *  *  *  * 

The  outdoor  work,  gardening,  poultry  keeping,  etc.,  has  been  most  successful  and 
is  being  introduced  in  every  center  where  the  conditions  permit.  As  in  the  arts  and 
crafts  work,  the  poultry  work  and  gardening  are  made  as  practical  as  possible,  the 
products  being  sold  and  the  profits  applied  to  the  extension  of  the  work  and  for  the 
benefit  of  the  men  engaged  in  it.  In  Winnipeg  between  $800  and  $900  worth  of  poul- 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     71 

try  and  garden  produce  was  raised  by  the  patients  at  the  local  convalescent  hospital 
during  last  summer.  Egg  circles  have  been  formed  in  connection  with  the  poultry 
classes  at  several  hospitals. 

The  whole  of  this  work  forms  part  of  the  daily  routine  of  the  hospitals.  After 
breakfast  and  morning  fatigue  duties  are  over,  a  regular  program  is  followed  from 
9  to  12.30  and,  after  dinner,  from  2  to  4.15. 

*  *  *  *  *  *  * 
The  question  as  to  what  new  occupations  a  disabled  man  might  be  trained  for  is 

first  of  all  a  medical  one,  though  it  is  largely  one  for  a  vocational  counselor,  a  man 
well  versed  in  a  knowledge  of  the  methods  of  various  industries  and  of  the  training 
necessary  for  those  who  desire  to  pursue  them.  But  further,  and  this  is  an  important 
consideration,  it  is  an  economic  question,  touching  the  law  of  supply  and  demand. 
While  there  are  a  number  of  occupations  for  which  it  is  not  difficult  to  train  men, 
it  does  not  follow  that  employment  can  readily  be  obtained  in  them.  Last,  but  by 
no  means  least,  the  man's  own  wishes  and  desires  for  his  future  must  be  consulted". 
The  question,  therefore,  is  an  individual  one,  and  every  case  is  investigated  separately. 
The  decision  as  to  the  occupation  for  which  an  opportunity  of  being  trained  is  to  be 
offered  a  man,  is  made  in  the  light  of  the  medical,  technical,  economic,  and  personal 
factors  of  his  case.  The  commission  has  established  a  complete  organization  for  carry- 
ing out  examination  and  for  determining  what  reeducation,  if  any,  should  be  given, 
to  the  discharged  men. 

*  *  #  *      .  «  *  * 
One  difficulty  with  which  the  commission  has  been  confronted  is  that  of  finding 

suitable  instructors.  The  supply  of  these  men  in  Canada,  skilled  in  vocational  and 
industrial  training,  was  all  too  limited  before  the  war.  Further,  a  number  have  gone 
overseas,  and  the  commission  has  found  it  necessary  in  several  instances  to  take  them 
from  the  combatant  ranks  to  serve  as  instructors  at  home.  Also,  and  this  will  probably 
increase,  disabled  men  are  being  engaged  as  instructors  whenever  available.  The 
commission  regards  the  work  of  vocational  training  and  reeducation  as  only  in  its 
infancy  and  there  will,  undoubtedly,  be  a  considerable  development  as  time  goes 
on  and  men  realize  the  advantages  offered. 

*  *  *  *  *  *  # 

One  of  the  first  things  recognized  by  the  commission  in  1915  was  the  necessity 
for  the  creation  of  machinery  for  introducing  returned  men  to  employment  and  a 
large  amount  of  consideration  was  given  to  this  problem.  It  was  recognized  that  this 
was  primarily  a  provincial  matter  and  it  was,  therefore  decided  to  request  the  Govern- 
ment to  call  an  interprovincial  conference  in  order  that  a  definite  scheme  of  organi- 
zation might  be  discussed  and,  if  approved,  promulgated.  At  the  instance  of  the 
president  of  the  commission  a  report  was  prepared  by  the  secretary  containing  certain 
recommendations  for  submission  to  this  conference.  The  report  was  published  as  a 
sessional  paper  in  October,  1915  (No.  35a). 


PART  IV. 
OUTLINE  FOR  AN  EXHAUSTIVE  STUDY  AND  REPORT. 

VOCATIONAL  REEDUCATION  AND  PLACEMENT  OF  DISABLED  SOLDIEES 

AND  SAILORS. 

/.   The  size  of  the  problem — Approximate  number  of  men  returned  disabled  each  year 
per  million  men  on  the  firing  line. 

A.  Classified  according  to  disabilities. 

B.  Classified  according  to  their  previous  occupations. 

C.  Classified  provisionally  according  to  their  vocational  capacities  as  handicapped 

men: 

1.  The  number  available  to  enter  immediately  upon  wage-earning  occupa- 

tions without  vocational  reeducation. 

2.  Probable  numbers  to  be  returned  to  agriculture,  industry,  commerce,  and 

the  professions — 

(a)  Before  vocational  reeducation. 
(6)  After  vocational  reeducation. 

3.  Probable  number  unable  to  compete  under  normal  labor  conditions. 

4.  The  totally  incapacitated  for  any  vocation. 

II.  Economic  and  ethical  issues. 

A.  Reasons  why  vocational  rehabilitation  of  disabled  soldiers  and  sailors  should  be' 

undertaken. 

B.  Public  versus  private  resources. 

C.  Public  versus  private  administration. 

D.  National  versus  State  administration. 

E.  Military  versus  no  military  discipline. 

F.  Principles  underlying  cooperation  with  the  States  and  municipalities. 

G.  Principles  underlying  cooperation  with  private  agencies. 

H.  Mollifications  of  national  and  State  laws  and  of  rules  and  policies  of  State  com- 
pensation commissions  necessary  in  order  to  provide  properly  for  the  placing 
of  handicapped  men. 

777.  Finances. 

A.  National  appropriation. 

1.  By  Congress. 

(a)  Lump  sum. 

(6)  Per  capita  per  man  handicapped. 

B.  Appropriation  by  other  public  agencies. 

1.  States. 

2.  Municipalities. 

C.  Appropriation  by  private  and  semipublic  agencies. 

1.  Red  Cross. 

2.  Private  foundations. 

3.  Individuals. 

4.  Corporations. 

5.  Trade-unions. 

6.  Fraternal  organizations. 

7.  Farmers'  unions,  granges,  etc. 

8.  Institutions,  such  as  hospitals,  schools,  etc. 

D.  Foreign  experience  in  regard  to  financing  the  problem. 

73 


74     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

IV.  Administrative  problems. 

A.  Existing  Federal  agencies  of  administration,  such  as  War  Department,   Navy 

Department,  and  Federal  Board  for  Vocational  Education. 

B.  Possible  new  agencies. 

C.  Extension  of  period  of  military  service  during  period  of  vocational  reeducation, 

or  reenlistment  for  such  training. 

D.  Discharge  from  military  discipline  and  supervision  after  release. 

E.  Legislation  necessary. 

V.  Cooperation. 

A.  Agencies  of  cooperation. 

1.  Federal  agencies  with  Federal  agencies;  e.  g.,  Federal  departments,  board, 

or  bureau  with  military  authorities  as  regards  registration  and  personal 
survey  of  all  men  received  and  discharged  and  in  the  provision  of 
therapeutic  and  other  occupations  training  in  convalescent  hospitals; 
Federal  board  with  Departments  of  Agriculture,  Labor,  and  Commerce 
with  regard  to  the  vocational  reeducation  of  disabled  soldiers  and 
sailors. 

2.  Federal  agencies  with  State  agencies;  e.  g.,  in  vocational  reeducation  in 

State  schools  and  institutions  and  in  placement  of  men  vocationally 
rehabilitated. 

3.  Federal  agencies  with  municipal  agencies;  e.  g.,  in  vocational  reeducation 

in  city  schools  and  institutions  and  in  placement  of  men  vocationally 
rehabilitated. 

4.  Federal  agencies  with  semipublic  institutions,  such  as  the  Red  Cross, 

e.  g.,  in  relief  work  for  those  unable  to  compete. 

5.  Federal  agencies  with  private  institutions  and  foundations,  e.  g.,  dispo- 

sition and  treatment  of  permanently  invalided. 

6.  Federal  agencies  with  social  agencies,  e.  g.,  in  social  rehabilitation  and 

follow-up  work. 

7.  Federal  agencies  with  individual  employers  and  corporations,  e.  g..  in 

providing  reeducation  and  employment  for  rehabilitated  men. 

8.  Federal  agencies  with  organized  employers,  such  as  the  National  Manu- 

facturers Association,  e.  g.,  in  adaptation  of  machinery,  devices,  and 
tools,  and  in  the  enforcement  of  the  determination  of  wage  boards,  etc. 

9.  Federal  agencies  with  organized  employes,  such  as  the  American  Federa- 

tion of  Labor,  e.  g.,  admission  of  partially  disabled  men  to  industrial 
establishments,  both  for  reeducation  and  later  permanent  employment, 
enforcement  of  determinations  of  wage  boards,  etc. 

10.  Federal  agencies  with  established  schools,  e.  g.,  assisting  in  the  prepara- 

tion of  the  special  type  of  instructor  required,  in  teacher  training,  and 
in  vocational  reeducation. 

11.  Federal  agencies  with  established  hospitals,  e.  g.,  cooperation  in  occu- 

pational therapy  and  orthopedic  treatment. 

B.  Foreign  experience  in  cooperation. 

VI.  Stages  in  rehabilitation. 

A.  Functional  reeducation,  direction  of  Medical  Department. 

1.  Vocational  expert  present  at  functional  tests.     (See  Purposes  and  results 

of  tests.) 

2.  Occupational  therapy  or  preparatory  vocational  reeducation  under  physi- 

cian's instructions. 

B.  Orthopedic  system,  direction  of  Medical  Department. 

1.  Consultation  with  vocational  expert  necessary  to  determine  kind,  type, 

and  purpose  of  prosthetic  appliance.  ("See  prosthetic  appliances, 
necessity  for  cooperation  of  vocational  expert.) 

2.  Occupational  therapy  or  training  preparatory  to  vocational  reeducation 

under  physician's  instructions. 

C.  Vocational  education,  direction  of  Vocational  Department. 

1.  Continued  coordination  with  Medical  Department  as  occasioned. 

D.  Placement,  direction  of  Vocational  Department. 

1.  Cooperation  of  manufacturers,  trade-unions,  etc. 

E.  Follow  work,  direction  of  social  agencies  either  established  by  or  instructed  by  and 

reporting  to  Vocational  Department. 


VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS.     75 

VII.   Curative  workshop. 

A.  Vocational  export's  advice  when  tests  and  choice  of  prosthetic  appliances  are  being 

made  by  physician. 

1.  Purposes  of  tests. 

(a)  To  determine  capacity  of  the  stump  for  reeducation. 

(6)  To  determine  the  amount  of  power  in  the  stump  by  laboratory 

experiments  with  the  use  of  arthrodynamoinetere,  argometrio 

cycle,  chirographs,  and  dynamographs. 

(c)  To  determine  condition  of  senses  (sight,  touch,  hearing). 
(a)  To  determine  condition   of  heart,    lungs,   and   ner\o   centers; 

including  test  to  measure  respiratory  changes  as  indicating 

degree  of  fatigue. 
(e)  To  determine  reflexes,  speed  of  reactions,  and  coordinations. 

2.  Results  of  tests 

(a)  Determination  of  the  proportion  among  the  maimed  and  muti- 
lated capable  of  reeducation. 

Vocational  expert's  advice  for  many  other  serious  disabilities, 
often  of  a  medical  nature. 

B.  Service  of  vocational  expert  in  occupational  therapy. 

1.  In  the  selection  of  appropriate  occupational  opportunities. 

2.  In  the  preparation  of  courses  of  instruction. 

3.  In  devising  methods  of  instruction. 

4.  In  the  selection  of  instructors. 

C.  Service  of  vocational  expert  in  instruction  or  training  preparatory  to  vocational 

reeducation. 

1.  In  the  selection  of  appropriate  courses,  both  as  occupational  tests  and  as 

preparatory  work. 

2.  In  the  preparation  of  courses  of  instruction. 

3.  In  devising  methods  of  instruction. 

4.  In  the  selection  of  instructors. 

D.  Provision  for  general  education. 

E.  Relation  of  curative  workshop  training  to  vocational  reeducation  for  new  or  old 

occupation  selected  for  a  disabled  man. 

VIII.   Vocational  training. 

A.  The  direction  in  consultation  with  medical  department  toward  an  occupation. 

B .  Occupational  possibilities  of  types  of  disabled  men  in  terms  of  the  requirements  of — 

1.  Agricultural  occupations. 

2.  Commercial  occupations. 

3.  Industrial  occupations. 

4.  Nautical  occupations. 

5.  Technical  occupations. 

6.  Professional  occupations,  etc. 

C.  The  formulation  of  courses  of  instruction  for  the  preparation  of  disabled  men  for 

service  in  new  and  old  occupations. 

D.  Provision  for  general  education. 

E.  General  improvement  classes  during  convalescence. 

F.  Cooperation — 

1.  With  existing  trade,  technical,  agricultural,  commercial,  and  professional 

and  other  schools. 

2.  With  commerce,  industry,  and  agriculture. 

G.  Provision  for  further  training  if  such  is  recommended  after  a  man's  military 

discharge. 

IX.  Functioning  of  the  vocational  expert. 

A.  With  reference  to  men  disabled  for  service.     Able  to  return  to  former  work  or 

work  for  which  they  need  no  vocational  reeducation. 

1.  Placement,  provided  former  position  not  open  or  possible. 

B.  With  reference  to  men  in  need  of  further  medical  treatment.     Upon  discharge 

will  be  able  to  follow  former  occupation  or  take  up  new  without  vocational 
reeducation. 

1.  Occupational  therapy. 

2.  Placement. 


76     VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

C.  With  reference  to  men  in  need  of  no  further  medical  treatment,  but  unable  to 

follow  former  occupation  and  requiring  to  take  up  new  vocation. 

1.  Vocational  reeducation. 

2.  Placement. 

D.  With  reference  to  men  in  need  of  further  medical  treatment  and  new  vocation. 

1.  Occupational  therapy  or  training  preparatory  to  vocational  reeducation. 

2.  Vocational  reeducation. 

3.  Placement. 

E.  With  reference  to  men  in  need  of  permanent  medical  supervision  or  unable  to 

compete  in  any  regular  vocation.     Not  totally  disabled  for  special  and  limited 
work. 

1.  Occupational  therapy  until  cured  as  far  as  possible. 

2.  Placement  in  workshop  especially  provided  for  this  class. 

F.  With  reference  to  men  totally  disabled  for  any  kind  or  degree  of  work. 

(It  is  considered  that  this  class  should  be  cared  for  exclusively  by  the  medical 
department.) 

X.  Placement. 

A.  National  central  administrative  office  of  placement. 

B.  Cooperation  of  Federal  and  State  employment  offices. 

C.  Cooperation  with  private  aid  for  placement. 

D.  Cooperation  with  organized  labor. 

E.  Cooperation  with  employers. 

F.  Advisory  wage  agreement  boards  to  provide  permanently  for  handicapped  men 

and  reexamine  men  for  efficiency  as  required. 

1.  To  prevent  exploitation  of  handicapped  workers. 

2.  To  prevent  failure  of  handicapped  men  to  compete  or  retain  positions 

after  vocational  reeducation. 

G.  Reservation  of  work  for  specific  disabilities  in  Government  offices,  factories,  and 

stores. 

XI.  Continuous  registration  and  follow-up  work. 

A.  Maintenance  of  wage  agreement. 

B.  Provision  for  unemployed. 

C.  Relief. 

D.  Maintenance  of  special  workshop  for  those  unable  to  compete. 

E.  Provisions  for  reenlistments  or  otherwise  for  training. 

F.  Provision  of  further  medical  treatment  in  military  hospitals  in  recurrent  cases. 

G.  Social  rehabilitation. 


PART  V. 
A  BIBLIOGRAPHY   OF  THE   WAR   CRIPPLE.1 

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J  Compiled  by  Douglas  C.  McMurtrie,  of  the  Red  Cross  Institute  for  Crippled  and  Disabled  Men. 

77 


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Vocational 


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100  VOCATIONAL  REHABILITATION  OF  DISABLED  SOLDIERS  AND  SAILORS. 

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D^J 

Roys 
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Duvernoy.  Les  mutil^s  dans  les  names  de  guerre.  Conference  Interallied  pour 
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Invalides  de  la  Guerre.  Rapports,  Paris,  1917,  271-289. 

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Ferrannini,  Luigi.  Sulla  obligatorieta  degli  atti  operativi  per  i  militari  malati  o 
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Fournier,  Lucien.  Nos  glorieux  estropies  et  la  travail.  La  Nature,  Paris,  1915, 
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Monsani,  Olga.  Le  commission!  di  Patrpnato,  Infprmazioni  e  Collocamento.  Bollet- 
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Storpi,  Mutilati,  Roma,  1917,  ii,  184-185. 

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Service  *  *  *  Westminster,  June  10-12, 1915,  London,  1915,  p.  1-6. 

Norme  provvisorie  per  la  esecuzipne  del  decreto  luogptenenziale  19  agosto  1916,  n. 
1012  per  Tassistenza  ai  mutilati,  agli  storpi  ed  ai  ciechi  della  guerra.  Bollettino 
della  Federazione  Nazionale  dei  Comitati  di  Assistenza  ai  Militari  Ciechi,  Storpi, 
Mutilati,  Roma,  1917,  ii,  8-16. 

Opera  (F)  della  Francia  per  i  mutilati  delta  guerra.  Bollettino  della  Federazione 
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1917,  ii,  159-160. 

Orlando.  I  premi  per  la  rieducazione  professionale.  Bollettino  della  Federazione 
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1917,  ii,  37-38. 

• .    Regplamento  per  Tesecuzione  della  Legge  25  Marzo  1917,  n.  481,  che  istituisce 

1'opera  nazionale  per  la  protezione  e  1' assistenza  degli  invalidi  della  guerra.  Bollet- 
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Storpi,  Mutilati,  Roma,  1917,  ii,  199-213. 

Paeuw,  Leon  de.  L'orientation  professionnelle.  In:  Conference  Interalliee  pour 
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Invalides  de  la  Guerre.  Rapports,  Paris,  1917,  p.  91-111. 

• .     La  reeducation  obligatoire.     In:  Conference  Interalliee  pour  1'Etude  de 

la  Reeducation  Professionnelle  et  des  Questions  qui  Interessent  les  Invalides  de  la 
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Paoletti,  Egido.  Nuovo  tipo  di  apparecchio  dimprotesi  per  mutilati  di  cpscia. 
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Pensione  (la)  privilegiata  di  guerra  non  puo  essere  mai  tolta  o  comunque  diminuita. 
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Veto  (i 

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THZS 


AN  INITIAL  FINE  OF  25  CENTS 

OVERDUE. 


371848 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 


